Arrhythmias and conduction disturbance
Comparison of Left Atrial Volumes and Function by Real-Time Three-Dimensional Echocardiography in Patients Having Catheter Ablation for Atrial Fibrillation With Persistence of Sinus Rhythm Versus Recurrent Atrial Fibrillation Three Months Later

https://doi.org/10.1016/j.amjcard.2008.05.048Get rights and content

Real-time 3-dimensional echocardiography (RT3DE) can provide a unique combination of accurate left atrial (LA) volume quantification and rapid, automatic assessment of LA function. The aim of the study was to evaluate the changes in LA volumes and function in patients with atrial fibrillation (AF) undergoing radiofrequency catheter ablation (RFCA) using RT3DE; 57 consecutive patients referred for RFCA were studied. Paroxysmal AF was present in 43 patients (75%) and persistent AF in 14 (25%). After a mean follow-up of 7.9 ± 2.7 months, patients were divided into 2 groups: successful RFCA (SR group) and recurrence of AF (AF group). RT3DE was performed before, within 3 days, and 3 months after RFCA to assess LA volumes (maximum, minimum, and preA) and LA functions (passive, active, and reservoir). A total of 38 patients (67%) had successful RFCA (SR group). Immediately after RFCA, no significant changes in LA volumes and function were observed. After 3 months, a significant reduction in LA volumes (maximum: 26 ± 8 to 23 ± 7 ml/m2, p <0.01) was noted only in the SR group, with a significant improvement in LA active (22 ± 8% to 33 ± 9%, p <0.01) and reservoir functions (116 ± 45% to 152 ± 54%, p <0.01). Conversely, the AF group showed a trend towards a deterioration of LA volumes and function. In conclusion, in patients who maintain sinus rhythm after RFCA, a significant reverse remodeling and functional improvement of the left atrium is observed using RT3DE.

Section snippets

Methods

In a 10-month period, 57 consecutive patients (56 ± 9 years; 44 men) with symptomatic drug-refractory AF, referred to our institution for RFCA in accordance to the current guidelines criteria, were included in this study. According to the American College of Cardiology/American Heart Association/European Society of Cardiology Guidelines definition,5 paroxysmal AF was present in 43 patients (75%), and persistent AF was present in the remaining 14 patients (25%); none had permanent AF. Mean AF

Results

Baseline clinical characteristics of the study population are summarized in Table 1. At baseline, RT3DE revealed a mild enlargement of LA volume and a moderate reduction in LAEF, LAactive, and LAreservoir (Table 2) compared with the reference values for a normal left atrium.9, 14 Left ventricular systolic and diastolic functions were normal, and in 27 patients mitral regurgitation was present (24 mild, 3 moderate; Table 3). Six patients were in AF at the baseline evaluation and all had a

Discussion

A summary of the main findings of the present study is that 3 months after RFCA, a significant reduction in LA volumes and a clear improvement of LA active contraction and LA reservoir function was observed in patients with a successful RFCA procedure, and patients with recurrence of AF after RFCA showed a trend towards a worsening of LA volumes and function.

In the present study, RT3DE was used to assess LA volumes and function in patients treated with RFCA for AF. The assessment of LA size is

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