The impact of radiofrequency wide circumferential pulmonary vein isolation on left atrial geometry in patients with recurrent atrial fibrillation

Introduction: We sought to investigate the net effect of wide area circumferential radiofrequency catheter ablation (WACA) on the atrial (LA) geometry. Methods and results: Seventy-one patients, who underwent a second PVI procedure, after index procedure of point-by-point WACA, for recurrent paroxysmal (n=31) or persistent (n=40) atrial fibrillation (AF) in our center were included. A three-dimension rotational angiography of the left atrium (3D-RA) under rapid ventricular pacing was performed immediately before ablation, at index and repeat ablation in all patients. LA geometry in terms of volume, sphericity and surface were assessed in all patients between first and second PVI. There was a statistical significant reduction of the LA volume (65,6 ± 14 ml/m2 vs 62,2 ± 15 ml/m2, p<0,001) and of the surface of the LA (74,4 ± 11,2 vs 70,4 ± 11,2 cm2/m2, p<0,001), whereas the sphericity of the LA increased significantly (82 ± 2% vs. 83 ± 2%, p=0,004) in all 71 patients. Patients with paroxysmal AF showed significant decrease of the LA volume (121,8 ± 25,7 vs 116 ± 32 ml, p=0,008) and increase of the LA sphericity (82,3 ± 2,1 vs 83,1 ± 2%, p=0,009). Patients with persistent AF showed significant decrease of the LA volume (133,5 ± 32 vs 126 ± 32 ml, p=0,005), but only a trend towards increased sphericity (82,4 ± 2,8 vs 83 ± 2,4%, p=ns). Conlusions: WACA results into significant reduction of the LA volume, LA surface area and into significant increase of the LA sphericity in treated patients with recurrent AF.