Paroxysmal atrial fibrillation significantly decreased the left atrial reservoir contribution to left ventricular filling compared to healthy volunteers (24% vs 39%, p=0.0010).
Observational (n=35)
No
Does atrial fibrillation and the Cox-Maze IV surgical ablation procedure alter left atrial function as measured by cMRI?
Paroxysmal atrial fibrillation and subsequent surgical ablation significantly alter left atrial function and regional wall motion as quantified by cMRI, though left ventricular function remains preserved.
Absolute Event Rate: 24% vs 39%
p-value: p=0.0010
OBJECTIVES: The effect of atrial fibrillation (AF) on left atrial (LA) function has not been well defined and has been largely based on limited echocardiographic evaluation. This study examined the effect of AF and a subsequent Cox-Maze IV (CMIV) procedure on atrial function. METHODS: Cardiac magnetic resonance imaging (cMRI) was performed in 20 healthy volunteers, 8 patients with paroxysmal atrial fibrillation (PAF) and 7 patients with persistent or long-standing persistent atrial fibrillation (LSP AF). Six of the PAF patients underwent surgical ablation with the CMIV procedure and 5 underwent both pre- and postoperative cMRIs. The persistent or LSP AF patients underwent only postoperative cMRIs because all scans were performed with patients in normal sinus rhythm. Volume-time curves throughout the cardiac cycle and regional wall shortening were evaluated using the cine images and compared across groups. RESULTS: Compared with normal volunteers, patients with PAF had significantly decreased reservoir contribution to left ventricular (LV) filling (P = 0.0010), an increased conduit function contribution (P = 0.04) and preserved booster pump function (P = 0.14). Following the CMIV procedure, significant reductions were noted with respect to reservoir and booster pump function, with corresponding increases in conduit function. These differences were more drastic in patients with persistent/LSP AF. Regional wall motion was significantly reduced by PAF in all wall segments (P < 0.05), but was not further reduced by the CMIV. Despite changes in LA function, LV function was preserved following surgery. CONCLUSIONS: PAF significantly altered LA function and has a detrimental effect on regional wall motion. Surgical intervention further altered LA function, but the reasons for this are likely multifactorial and not entirely related to the lesion set itself.
Robertson et al. (2014) conducted an observational in Atrial fibrillation (n=35). Paroxysmal atrial fibrillation vs. Healthy volunteers was evaluated on Left atrial reservoir volume contribution to left ventricular filling (LARV%) (p=0.0010). Paroxysmal atrial fibrillation significantly decreased the left atrial reservoir contribution to left ventricular filling compared to healthy volunteers (24% vs 39%, p=0.0010).