Left atrial ejection fraction was preserved after successful circumferential pulmonary vein ablation (40% vs 38%; P=0.27) but decreased in patients with arrhythmia recurrences (37% vs 27%; P<0.001).
Cohort (n=55)
Does circumferential pulmonary vein ablation preserve left atrial contractility in patients with atrial fibrillation?
Successful circumferential pulmonary vein ablation preserves or improves left atrial ejection fraction, whereas recurrence of arrhythmia is associated with decreased left atrial contractility.
Absolute Event Rate: 27% vs 37%
p-value: p=<0.001
INTRODUCTION: Circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF) consists of creating extensive lesions in the left atrium (LA). The aim of the study was to evaluate changes in LA contractility after ablation and their relationship with procedure outcome. METHODS AND RESULTS: A series of 90 consecutive patients underwent cardiac magnetic resonance imaging (MRI) before and 4-6 months after CPVA. Only patients in sinus rhythm during both imaging acquisitions were included in the study to measure LA end-diastolic (LAmax) and LA end-systolic (LAmin) volumes. Fifty-five patients were finally analyzed (41 men, 52 +/- 11 years, 74% paroxysmal AF). During a mean follow-up of 12 +/- 7 months and after 1.2 +/- 0.3 ablation procedures, 38 patients (69%) were arrhythmia-free (group I), and the remaining 17 patients had recurrences (group II). There was a significant decrease in mean LAmax volume in both groups, whereas mean LAmin volume only decreased in group I. Mean LA ejection fraction (EF) was preserved after CPVA in group I (40 +/- 11% vs 38 +/- 10%; P = 0.27) but decreased in patients with arrhythmia recurrences (37 +/- 10% vs 27 +/- 10%; P < 0.001). In fact, LA EF remained stable or increased in 68% of patients without arrhythmia recurrences. CONCLUSIONS: LAmax volume reduction following CPVA occurs regardless of the clinical efficacy of the procedure, whereas mean LAmin volume only decreased in patients without recurrences. LA EF was preserved or even increased in most patients with successful CPVA.
Perea et al. (2008) conducted a cohort in Atrial Fibrillation (n=55). Circumferential pulmonary vein ablation (CPVA) vs. Baseline (pre-ablation) was evaluated on Left atrial ejection fraction (LA EF) in patients with arrhythmia recurrences (p=<0.001). Left atrial ejection fraction was preserved after successful circumferential pulmonary vein ablation (40% vs 38%; P=0.27) but decreased in patients with arrhythmia recurrences (37% vs 27%; P<0.001).