Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?

Abstract

BackgroundRadiofrequency catheter ablation of atrial fibrillation (AF) has been proved to be effective and to prevent progressive left atrial (LA) remodeling. Cryoballoon catheter ablation (CCA), using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling.Methods36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV) and LA volume index (LAVI) were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aasept, Aalat), LA filling fraction (LAFF), LA emptying fraction (LAEF) and the systolic fraction of pulmonary venous flow (PVSF). Detailed left ventricular diastolic function assessment was also performed.ResultsExcluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%). In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p < 0.05), maximal LAV (73 ± 23 to 81 ± 24 ml; p < 0.05), LAVI (35 ± 10 to 39 ± 11 ml/m2; p = 0.01) and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p < 0.01) had all increased. PVSF (58 ± 9 to 50 ± 10%; p = 0.01) and LAFF (36 ± 7 to 33 ± 8%; p = 0.03) had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits.ConclusionsIn patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.

The impact of cryoballoon-based catheter ablation on left atrial structural and potential electrical remodeling in patients with paroxysmal atrial fibrillation

“…Contrarily, among patients with AF recurrence, both structural and electrical remodeling showed a non-significant change during follow-up period. However, the study by Erdei et al [7] have significant difference from our study. First, they included patients with various risk factors for LA remodeling such as hypertension and coronary artery disease.…”

“…Second, the recurrence rate was importantly high at 12-month follow-up (58 %) in the study by Erdei et al [7] as compared to lower recurrence rate in our study (21.9 %). Third, the study group of Erdei et al [7] revealed a higher LA dimensions (55±5 mm) which implies the preprocedural progressive structural remodeling and makes reverse remodeling more difficult. However, in our study, we excluded patients with LA diameter of >55 mm which prevents the inclusion of patients with probably irreversible LA remodeling.…”

“…The efficacy of radiofrequency AF ablation has been evidenced regarding the prevention of progressive LA remodeling [3,5,6]. However, there was little data regarding the impact of cryoballoon-based AF ablation on atrial reverse remodeling [7]. Also, both structural and electrical reverse remodeling has not been evaluated in the same study previously.…”

“…We proposed that there might be differences among ablation tecniques regarding the effect on LA remodeling. In only one study reported by Erdei et al [7], it was shown that patients with AF recurrence during 1-year follow-up after cryoablation, LA size had increased and LA function had declined. But, they also reported that successful cryoballoon-based AF ablation prevented progressive LA remodeling.…”

Comparison of the Disordered Mechanical Function of the Left Atrium After Antral Isolation of Pulmonary Veins by Radiofrequency or Cryoballoon Ablation

“…Немногочисленные исследования по изучению влияния криобаллонной изоляции ЛВ на функцию ЛП демонстрируют, что в случае неуспеха процедуры имеет место прогрессирующее ухудшение механиче-ской функции, в то же время, при отсутствии рециди-вов ФП с шестого месяца после вмешательства име-ется тенденция к ее восстановлению [17,18]. Эти данные согласуются с результатами мета-анализа по оценке функции ЛП после РЧ изоляции ЛВ [9].…”