Pulmonary vein remodeling following pulmonary vein isolation in patients with atrial fibrillation—do pulmonary veins represent only an epiphenomenon? A cardiac MRI study

Khidr, Shimaa; Doyle, Mark; Rayarao, Geetha; Ghany, Mohamed Abdel; Hasan‐Ali, Hosam; Fouad, Doaa A; Belden, William; Biederman, Robert W

doi:10.21037/cdt.2018.09.07

Cited by 3 publications

(7 citation statements)

References 23 publications

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“…It is generally known that the reverse remodeling of the LAs occurs after successful PV isolation for AF 3–5 . Khidr et al reported that reduction in PV cross‐sectional areas correlated with the LA volume reduction after PV isolation by RFA and suggested that reverse remodeling of the PVs reflects that of the LA 4 . Similar to this study, the morphological changes in the PVs after CBA should also be analyzed by considering the effect of volume reduction of LA.…”

Section: Discussionsupporting

confidence: 63%

“…This may suggest that the postoperative reduction in PV area can be explained by the effect of shrinkage of the LA. It is generally known that the reverse remodeling of the LAs occurs after successful PV isolation for AF 3–5 . Khidr et al reported that reduction in PV cross‐sectional areas correlated with the LA volume reduction after PV isolation by RFA and suggested that reverse remodeling of the PVs reflects that of the LA 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary vein (PV) stenosis after CBA is reported to be relatively small in magnitude; several risk factors have been mentioned in prior reports 1,2 . Although postoperative PV and left atrium (LA) shrinkage have been reported after PV isolation, 3–5 no studies have clarified the relationship between anatomical changes in PVs and LA along with PV stenosis. Moreover, the actual incidence of PV stenosis and the details of risk predictors vary across reports and remain controversial 2,6 …”

Section: Introductionmentioning

confidence: 99%

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Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

Miyama

Takatsuki

Hashimoto

et al. 2020

Pacing Clinical Electrophis

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Background: The anatomical changes in pulmonary veins (PVs) after cryoballoon ablation (CBA) are unclear. We aimed to determine the morphological changes in the PVs and left atrium (LA) along with the predictive factors for clinical PV stenosis. Methods: We analyzed data of 320 PVs from 80 patients who underwent CBA for atrial fibrillation (age: 62 ± 10 years, 59 males). All patients underwent pre-and postprocedural cardiac computed tomography. We defined clinical PV stenosis when the cross-sectional area decreased by more than 50%. Results: The average ostial PV area and LA volume decreased significantly after CBA (pre-vs post-CBA; 2.4 ± 1.0 cm 2 vs 2.3±1.1 cm 2 , P < .001, 75.0 ± 23.2 cm 3 vs 70.7 ± 21.9 cm 3 , P < .001, respectively). There was a significant correlation between the reduction rates of the PV area and those of LA volume (R = 0.411, P < .001). The larger preoperative PV area and greater reduction in LA volume were associated with advanced PV narrowing. Clinical PV stenosis was observed in six PVs, was more common in females (male vs female; 0.8% vs 4.8%, P = .043), and tended to be more frequent in left PVs (left PVs vs right PVs; 3.1% vs 0.6%: P = .107), irrespective of the LA volume reduction. Conclusions: The significant reduction of the ostial PV area occurred after CBA, which correlated with the reduction rate of LA volume. The narrowing of the PV was partly produced by the LA volume reduction. Clinical PV stenosis was more common in females and tended to be more frequent in left PVs.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

Miyama

Takatsuki

Hashimoto

et al. 2020

Pacing Clinical Electrophis

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“…Consistent with this conceptual model, several previous studies have shown reverse structural remodeling following catheter ablation therapy. [7][8][9][10][11][12][13]17 To date, data are limited about remodeling in drug treated patients.…”

Section: Discussionmentioning

confidence: 99%

“…6 Following catheter ablation therapy, decreases in left atrial volume and PV diameters (reverse structural remodeling) have been observed. [7][8][9][10][11][12][13][14][15][16] The clinical consequences of reverse remodeling are not well defined, but some studies have reported that reverse remodeling is associated with decreased AF recurrence 10,12 and improved cardiac function. 10 While reverse remodeling after catheter ablation therapy has been shown in several previous studies, [7][8][9][10][11][12][13]17 none have compared the magnitude of reverse remodeling changes in ablation with an appropriately selected control group of patients treated with drug therapy.…”

mentioning

confidence: 99%

Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy

Rettmann

Holmes²,

Monahan

et al. 2021

Circ: Arrhythmia and Electrophysiology

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Background - The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial was a randomized, prospective trial of left atrial catheter ablation versus drug therapy for treatment of atrial fibrillation (AF). As part of CABANA, a prospective imaging sub-study was conducted. The main objectives were to describe the patterns of changes in the dimensions of the left atrium (LA) and pulmonary veins (PVs), and the relationship between these changes with treatment assignment and clinical outcomes. Methods - CT or MRI was acquired at baseline and follow-up in 121 ablation (median follow-up 101 days) and 85 drug patients (median follow-up 97 days). Left atrial volume index (LAVI), mean PV ostial diameter (MPV) , and ostial diameters of each PV separately were computed. We examined the relationship between the change from baseline to follow-up with subsequent clinical outcomes (composite of death, disabling stroke, serious bleeding, or cardiac arrest [CABANA primary endpoint], total mortality or cardiovascular hospitalization, first AF recurrence after the 90 day blanking period, first AF/atrial flutter/ atrial tachycardia after the 90 day blanking period) using Cox proportional-hazards models. Results - The median (25 th , 75 th ) change from baseline for LAVI was -7.8 mL/m 2 (-16.4, 0.2), ablation arm and -3.5 mL/m 2 (-11.4, 2.6), drug therapy arm. The LAVI decreased in 52.9% of ablation patients versus 40.0% of drug therapy patients. Change for MPV was -2.7 mm (-4.2, -1.3) in the ablation arm versus -0.1 mm (-1.5, 0.8) in the drug therapy arm. Changes in LA and PV dimensions had no consistent relationship with the risk of developing the study primary endpoint. Reductions in LAVI, and in MPV diameter were associated with decreased risk of AF recurrence. Conclusions - Ablation patients demonstrated more frequent and larger atrial structural changes compared with drug patients. These changes suggest a critical relationship between structural features and AF generation.

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Сhanges in the deformation of the pulmonary vein ostia after radiofrequency and cryoballoon ablation in patients with paroxysmal atrial fibrillation

Sitkova

Usenkov

Archakov

et al. 2023

Vestnik aritmologii

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Aim. To study changes in pulmonary vein ostia strain after radiofrequency (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF) by intracardiac echocardiography.Methods. Patients with paroxysmal AF (n=41) aged 60.1±7.1 years and duration of the disease 7.7±4.8 years were included in the study. Pulmonary vein (PV) isolation was performed with RFA (n=23) and CBA (n=18). All patients underwent transthoracic and intraoperative intracardiac echocardiography. Longitudinal strain of PV ostia was assessed before and after isolation.Results. Groups were comparable in main clinical parameters. Regress of PV ostia strain after RFA and CBA was achieved in all of PV, which corresponded to complete PV isolation. Remarked trend toward a more pronounced regression of PV ostia longitudinal strain after CBA compared with RFA for left superior (10±0.7% and 6.1±0.8% respectively, p<0.001) and right inferior PV (9.3±0.7% vs 7.3±0.6%, p<0.001) requires continued observation and analysis of data in a larger group. There were no complications.Conclusion. PV isolation is accompanied by a significant change in their longitudinal strain using intracardiac echocardiography both after CBA and after RFA.

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Pulmonary vein remodeling following pulmonary vein isolation in patients with atrial fibrillation—do pulmonary veins represent only an epiphenomenon? A cardiac MRI study

Cited by 3 publications

References 23 publications

Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy

Сhanges in the deformation of the pulmonary vein ostia after radiofrequency and cryoballoon ablation in patients with paroxysmal atrial fibrillation

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