Changes in Left Atrial Transport Function in Patients Who Maintained Sinus Rhythm After Successful Radiofrequency Catheter Ablation for Atrial Fibrillation: A 1‐Year Follow‐Up Multislice Computed Tomography Study

Kim, Jin-Seok; Im, Sung Il; Shin, Seung Yong; Kang, Jun Hyuk; Na, Jin Oh; Choi, Cheol Ung; Kim, Seong Hwan; Kim, Eung Ju; Rha, Seung Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Hwang, Chun; Kim, Young-Hoon; Yong, Hwan Seok; Lim, Hong Euy

doi:10.1111/jce.13128

Cited by 10 publications

(8 citation statements)

References 26 publications

(38 reference statements)

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“…It is noteworthy that two‐dimensional echocardiography, RT3DE, computed tomography and cardiac magnetic resonance have all been utilized in studies for this purpose. LAEF preservation, deterioration or improvement in distinct subgroups (based on baseline atrial function or on AFib recurrence) after pulmonary vein isolation have been reported. The intrinsic dissimilarities of different imaging approaches along with potential methodological issues (for instance, heart rhythm at the time of measurement acquisition) may be responsible for the contradictory findings .…”

Section: Discussionmentioning

confidence: 99%

Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study)

Γιαννόπουλος

Kossyvakis

Vrachatis

et al. 2019

Cardiovasc electrophysiol

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Background: Isolation of the pulmonary veins (PVI) has become a mainstay in atrial fibrillation (AFib) therapy. Lesions in left atrial tissue lead to scar formation and this may affect left atrial function.Methods: Patients with paroxysmal AFib were randomly assigned in a 1:2 allocation scheme to radiofrequency (RF) ablation or cryoballoon. Real-time three-dimensional echocardiography was performed (under sinus rhythm in all cases) before ablation and at 1 and 3 months to evaluate the left atrial functional indices. The primary outcome measure was change in left atrial ejection fraction (LAEF) at 1 month.Results: 120 patients were randomized (80 to cryoballoon, 40 to RF). The absolute change in LAEF at 1 month was 4.0 (Q1-Q3, −0.1to 7.6)% in the cryoballoon group and −0.8 (Q1-Q3, −1.9 to 0.9)% in the RF group (P < 0.001 for the comparison between groups). At 3 months, the corresponding changes were 6.7 (Q1-Q3, 3.4-11.2)% and 0.7 (Q1-Q3, −0.7 to 3.5)%, respectively (P < 0.001). Overall, the rate of patients with lower LAEF at 3 months compared to baseline was 2.5% in the cryoballoon group and 32.5% in the RF group (P < 0.001). AFib recurrence rate at 6 months was higher in patients with decreased LAEF (odds ratio, 6.2; 95% confidence interval, 2.0-19.5; P = 0.002). Conclusion:The Cryo-LAEF study prospectively compared the effects of RF and cryoballoon ablation on left atrial function. Both at 1 and 3 months postablation, LAEF was either improved or stable in both ablation groups. K E Y W O R D S ablation, atrial fibrillation, cryoablation, emptying fraction, left atrial ejection fraction J Cardiovasc Electrophysiol. 2019;30:991-998.wileyonlinelibrary.com/journal/jce

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Section: Discussionmentioning

confidence: 99%

Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study)

Γιαννόπουλος

Kossyvakis

Vrachatis

et al. 2019

Cardiovasc electrophysiol

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“…AF can lead to reversible chamber dilatation and dysfunction of LA with the extent of rate-related cardiomyopathy (1). Shrinkage of the large LA chamber may occur in patients who undergo catheter ablation of AF, and it has been defined as a reverse remodeling of left atrium (19,20). This remodeling may be due to the decreased burden of AF and scar formation from the catheter ablation (20).…”

Section: Discussionmentioning

confidence: 99%

“…Shrinkage of the large LA chamber may occur in patients who undergo catheter ablation of AF, and it has been defined as a reverse remodeling of left atrium (19,20). This remodeling may be due to the decreased burden of AF and scar formation from the catheter ablation (20). The degree of LA shrinkage strongly correlates with the extent of ablation-induced scarring in the LA wall after catheter ablation of AF.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Left Atrial Appendage Isolation Using Cardiac MRI after Catheter Ablation of Atrial Fibrillation: Paradox of Appendage Reservoir

Cho

Shim

et al. 2021

Korean J Radiol

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Objective: To assess the effect of left atrial appendage (LAA) isolation on LAA emptying and left atrial (LA) function using cardiac MRI in patients who underwent successful catheter ablation of atrial fibrillation (AF). Materials and Methods: This retrospective study included 84 patients (mean age, 59 ± 10 years; 67 males) who underwent cardiac MRI after successful catheter ablation of AF. According to the electrical activity of LAA after catheter ablation, patients showed either LAA isolation or LAA normal activity. The LAA emptying phase (LAA-EP, in the systolic phase [SP] or diastolic phase), LAA emptying flux (LAA-EF, mL/s), and LA ejection fraction (LAEF, %) were evaluated by cardiac MRI. Results: Of the 84 patients, 61 (73%) and 23 (27%) patients showed LAA normal activity and LAA isolation, respectively. Incidence of LAA emptying in SP was significantly higher in LAA isolation (91% vs. 0%, p < 0.001) than in LAA normal activation. LAA-EF was significantly lower in LAA isolation (40.1 ± 16.2 mL/s vs. 80.2 ± 25.1 mL/s, p < 0.001) than in LAA normal activity. Furthermore, LAEF was significantly lower in LAA isolation (23.7% ± 11.2% vs. 31.1% ± 16.6%, p = 0.04) than in LAA normal activity. Multivariate analysis demonstrated that the LAA-EP was independent from LAEF (p = 0.01). Conclusion: LAA emptying in SP may be a critical characteristic of LAA isolation, and it may adversely affect the LAEF after catheter ablation of AF.

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“…In patients with healthy atria who typically have only paroxysmal AF, the consequences of the injury may be modest 23 . However, the procedure-related cardiomyocyte loss eventually leads to replacement fibrosis, and in patients with long-standing AF and severely diseased atria, ablation-induced injury can have serious deleterious effects on LA structure and function ( Take home figure ) 24 . The quantity of loss of contractile tissue and replacement fibrosis depends on the extent or number of procedures, but 30–35% of the LA wall may be replaced by scar following ablation 25 , 26 .…”

Section: Characterization Of Left Atrial Injury Induced By Catheter Amentioning

confidence: 99%

“…Ablation is followed by impairment of LA systolic function, which is related to the magnitude of scar formation 20 . During follow-up, 40–70% of patients who undergo ablation show a decrease in LA ejection fraction, particularly if they have demonstrated biochemical evidence of cardiomyocyte death (as reflected by CK-MB and troponin release); this is especially likely with extensive or multiple procedures 24 . In one-third of patients, restoration of electrocardiographic P waves is not accompanied by haemodynamic evidence of meaningful atrial systole, i.e.…”

Section: Consequences Of the Effect Of Ablation On Left Atrial Systolmentioning

confidence: 99%

Effect of catheter ablation on pre-existing abnormalities of left atrial systolic, diastolic, and neurohormonal functions in patients with chronic heart failure and atrial fibrillation

Packer

2019

European Heart Journal

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The critical role of the left atrium (LA) in cardiovascular homoeostasis is mediated by its reservoir, conduit, systolic, and neurohormonal functions. Atrial fibrillation is generally a reflection of underlying disease of the LA, especially in patients with heart failure. Disease-related LA remodelling leads to a decline in both atrial contractility and distensibility along with an impairment in the control of neurohormonal systems that regulate intravascular volume. Catheter ablation can lead to further injury to the atrial myocardium, as evidenced by post-procedural troponin release and tissue oedema. The cardiomyocyte loss leads to replacement fibrosis, which may affect up to 30–35% of the LA wall. These alterations further impair atrial force generation and neurohormonal functions; the additional loss of atrial distensibility can lead to a ‘stiff LA syndrome’, and the fibrotic response predisposes to recurrence of the atrial arrhythmia. Although it intends to restore LA systole, catheter ablation often decreases the chamber’s transport functions. This is particularly likely in patients with long-standing atrial fibrillation and pre-existing LA fibrosis, especially those with increased epicardial adipose tissue (e.g. patients with obesity, diabetes and/or heart failure with a preserved ejection fraction). Although the fibrotic LA in these individuals is an ideal substrate for the development of atrial fibrillation, it may be a suboptimal substrate for catheter ablation. Such patients are not likely to experience long-term restoration of sinus rhythm, and catheter ablation has the potential to worsen their haemodynamic and clinical status. Further studies in this vulnerable group of patients are needed.

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Changes in Left Atrial Transport Function in Patients Who Maintained Sinus Rhythm After Successful Radiofrequency Catheter Ablation for Atrial Fibrillation: A 1‐Year Follow‐Up Multislice Computed Tomography Study

Cited by 10 publications

References 26 publications

Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study)

Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study)

Evaluation of Left Atrial Appendage Isolation Using Cardiac MRI after Catheter Ablation of Atrial Fibrillation: Paradox of Appendage Reservoir

Effect of catheter ablation on pre-existing abnormalities of left atrial systolic, diastolic, and neurohormonal functions in patients with chronic heart failure and atrial fibrillation

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