The impact of radiofrequency wide circumferential pulmonary vein
isolation on left atrial geometry in patients with recurrent atrial
fibrillation
Abstract
Introduction: We sought to investigate the net effect of wide area
circumferential radiofrequency catheter ablation (WACA) on the atrial
(LA) geometry. Methods and results: Seventy-one patients, who underwent
a second PVI procedure, after index procedure of point-by-point WACA,
for recurrent paroxysmal (n=31) or persistent (n=40) atrial fibrillation
(AF) in our center were included. A three-dimension rotational
angiography of the left atrium (3D-RA) under rapid ventricular pacing
was performed immediately before ablation, at index and repeat ablation
in all patients. LA geometry in terms of volume, sphericity and surface
were assessed in all patients between first and second PVI. There was a
statistical significant reduction of the LA volume (65,6 ± 14 ml/m2 vs
62,2 ± 15 ml/m2, p<0,001) and of the surface of the LA (74,4 ±
11,2 vs 70,4 ± 11,2 cm2/m2, p<0,001), whereas the sphericity
of the LA increased significantly (82 ± 2% vs. 83 ± 2%, p=0,004) in
all 71 patients. Patients with paroxysmal AF showed significant decrease
of the LA volume (121,8 ± 25,7 vs 116 ± 32 ml, p=0,008) and increase of
the LA sphericity (82,3 ± 2,1 vs 83,1 ± 2%, p=0,009). Patients with
persistent AF showed significant decrease of the LA volume (133,5 ± 32
vs 126 ± 32 ml, p=0,005), but only a trend towards increased sphericity
(82,4 ± 2,8 vs 83 ± 2,4%, p=ns). Conlusions: WACA
results into significant reduction of the LA volume, LA surface area and
into significant increase of the LA sphericity in treated patients with
recurrent AF.