Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size

Abstract

Background-The objective of the present study was to evaluate the relation between freedom from atrial fibrillation (AF) and left atrial (LA) size in patients who underwent circumferential pulmonary vein (PV) isolation and LA ablation. Methods and Results-One hundred five consecutive patients with symptomatic and drug-refractory paroxysmal or persistent AF were included in the present study. The mean age was 52Ϯ9.5 years (range, 27 to 75 years); 74 patients (70%) were male. Paroxysmal AF was present in 52 (49.5%) and persistent AF in 53 (50.5%) patients. Mean AF duration was 6.0Ϯ5.1 years in the paroxysmal AF group and 7.6Ϯ6.0 years in the persistent AF group. A 3D electroanatomic map of the LA including the PV ostia was constructed with a nonfluoroscopic navigation system (Carto, Biosense Webster). Left-and right-sided PVs were encircled by continuous radiofrequency ablation lines. We performed 128 ablation procedures in 105 patients, ie, 23 redo procedures. The mean long-term follow-up duration was 14.6Ϯ4.9 months (range, 6 to 24 months). Sinus rhythm was present in 45 patients (86.5%) in the paroxysmal AF group and in 41 patients (77.3%) in the persistent AF group at the latest follow-up. Six months after ablation, LA dimension in the persistent AF subjects who remained in sinus rhythm decreased from 44.0Ϯ5.8 to 40Ϯ4.5 mm (range, 31 to 51 mm). In contrast, in patients with recurrences of AF, LA dimension increased from 45Ϯ6.5 to 49Ϯ5.4 mm (range, 32 to 59 mm). In the successfully treated paroxysmal AF group, LA dimension decreased from 40.5Ϯ4.4 to 37.5Ϯ3.5 mm (PϽ0.01). Conclusions-In radiofrequency ablation of AF using an electroanatomic approach, there is a statistically significant relationship between medium-term procedural success and LA size: persistent sinus rhythm is associated with reduced and recurrent AF with increased LA dimensions.

Atrial Electroanatomical Remodeling as a Determinant of Different Outcomes Between Two Current Ablation Strategies: Circumferential Pulmonary Vein Isolation Vs Pulmonary Vein Isolation

“…These previous studies suggest that relatively less dilated atria would have less structural arrhythmogenic substrate. Beukema et al 6 reported that the extent of myocardial damage incurred by ablation correlates with an arrhythmia-free outcome in circumferential LA ablation. A wide reduction of substrate by circumferential LA ablation may be effective only in dilated atria with much more structural substrates.…”

“…4,5 The incremental efficacy of circumferential LA ablation has been suggested to be attributable to a wide reduction in the anatomical and electrical substrate, that is, atrial debulking. 6,7 On the other hand, LA enlargement is accompanied by structural remodeling associated with the substrate of AF. 8 -11 It has not been established whether the atrial debulking strategy as a ''wide area'' ablation can be applied to patients with less dilated LA and, accordingly, relatively less substrate of AF.…”

Echocardiographic Biatrial Remodelling and Diastolic Function Assessment in Long-Term Follow-Up after Typical Atrial Flutter Ablation

“…Median mitral A wave velocity was 0.76 m/s and mitral E wave velocity 0.78 m/s. Several studies described structural reverse remodelling of the LA after pulmonary vein isolation as treatment of AF [3,4,[11][12][13][14][15]. Muller et al [16] documented a reverse remodelling in both atria after AF ablation.…”

Atrial Remodeling And Atrial Fibrillation: Mechanistic Interactions And Clinical Implications

“…Conversion of AF to sinus rhythm, whether by electrical cardioversion or radiofrequency ablation, has been shown to reduce LA size [204][205][206][207] and improve LA function. 208,209 Reversal of electrical remodeling can usually be rapidly achieved, 210,211 but vulnerability to the recurrence of AF depends on the amount of atrial fibrosis and the size of the LA.…”