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Left Atrial Function After Ablation for Paroxysmal Atrial Fibrillation

2008; Elsevier BV; Volume: 103; Issue: 3 Linguagem: Inglês

10.1016/j.amjcard.2008.09.094

1879-1913

Ana Clara Tude Rodrigues, Mauricio I. Scannavacca, Márcia Azevedo Caldas, Viviane Tiemi Hotta, Cristiano Pisani, Eduardo Sosa, Wilson Mathias,

Cardiac Arrhythmias and Treatments

Radiofrequency ablation of the pulmonary veins has been used to treat patients with paroxysmal atrial fibrillation (AF), and atrial damage after ablation is an issue of concern. To evaluate left atrial function shortly and midterm after ablation, 33 consecutive patients with paroxysmal AF were studied at baseline, 24 hours, and ≥6 months after ablation. Patients in sinus rhythm with normal ventricular function were included in the study. Echocardiographic measurements of left atrial volumes (Simpson's rule) and transmitral and tissue Doppler myocardial (A′) velocities at the septal and lateral mitral annulus were undertaken at each time. Left atrial emptying fraction (EF; maximal − minimal left atrial volume/maximal left atrial volume) was used to express left atrial function. After 8 ± 2 months, 30 of 33 patients returned (23 men, age 53 ± 13 years), and all except 2 were in sinus rhythm. Shortly after ablation, left atrial minimal volumes increased (from 30 ± 15 to 35 ± 15 ml; p = 0.02), with maximal volumes unchanged, resulting in decreased left atrial EF (from 47 ± 8 to 40 ± 7 ml; p <0.05). Tissue Doppler septal A′ velocities also decreased (from 8.2 ± 1.8 to 6.9 ± 2.0 cm/s; p <0.05). However, after midterm follow-up, both left atrial EF and septal A′ velocities had slightly increased compared with shortly after ablation, although left atrial volumes remained similar to baseline. Septal A′ velocity changes paralleled left atrial EF both shortly (r = 0.46, p = 0.02) and at midterm after ablation (r = 0.47, p = 0.01). In conclusion, after radiofrequency ablation, patients with paroxysmal AF experienced an initial impairment in atrial function, with improvement at longer term follow-up. Radiofrequency ablation of the pulmonary veins has been used to treat patients with paroxysmal atrial fibrillation (AF), and atrial damage after ablation is an issue of concern. To evaluate left atrial function shortly and midterm after ablation, 33 consecutive patients with paroxysmal AF were studied at baseline, 24 hours, and ≥6 months after ablation. Patients in sinus rhythm with normal ventricular function were included in the study. Echocardiographic measurements of left atrial volumes (Simpson's rule) and transmitral and tissue Doppler myocardial (A′) velocities at the septal and lateral mitral annulus were undertaken at each time. Left atrial emptying fraction (EF; maximal − minimal left atrial volume/maximal left atrial volume) was used to express left atrial function. After 8 ± 2 months, 30 of 33 patients returned (23 men, age 53 ± 13 years), and all except 2 were in sinus rhythm. Shortly after ablation, left atrial minimal volumes increased (from 30 ± 15 to 35 ± 15 ml; p = 0.02), with maximal volumes unchanged, resulting in decreased left atrial EF (from 47 ± 8 to 40 ± 7 ml; p <0.05). Tissue Doppler septal A′ velocities also decreased (from 8.2 ± 1.8 to 6.9 ± 2.0 cm/s; p <0.05). However, after midterm follow-up, both left atrial EF and septal A′ velocities had slightly increased compared with shortly after ablation, although left atrial volumes remained similar to baseline. Septal A′ velocity changes paralleled left atrial EF both shortly (r = 0.46, p = 0.02) and at midterm after ablation (r = 0.47, p = 0.01). In conclusion, after radiofrequency ablation, patients with paroxysmal AF experienced an initial impairment in atrial function, with improvement at longer term follow-up.