REVERSE LEFT ATRIAL REMODELING ASSESSMENT AFTER PAROXYSMAL ATRIAL FIBRILLATION ABLATION: OUR FIRST EXPERIENCE

Authors

  • Mihaela GRECU “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases Iasi
  • Mariana FLORIA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Raluca-Ozana CHISTOL “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Gr TINICĂ “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Keywords:

ATRIAL FIBRILLATION, LEFT ATRIUM, VOLUME, REMODELING

Abstract

We aimed to assess reverse left atrial (LA) remodeling at 6 months after ablation of paroxysmal atrial fibrillation (AF), and to identify the most relevant parameter of reverse LA remodeling. Ma-terial and methods: Left atrial size was assessed by echocardiography: antero-posterior (AP) diameter, LA area in apical 4 and 2 chambers (A4c, A2c), LA volume by biplane for-mula (LAV1), and by computed-tomography (LAV2). Results: Seventy-eight consecutive patients with mean age of 57.41 ± 8.05 years were prospectively included; 60 (76.9%) were with paroxysmal AF less than 24 hours and 18 (23.1%) less than 7 days duration. All echo-cardiographic and computed-tomographic evaluations were made within 4 weeks before ab-lation and at 6 months after ablation procedure by the same operator. Circumferential or segmental pulmonary vein isolation was performed by radiofrequency in 58 (74.4%) pa-tients, and by cryotherapy in 18 (23.1%) patients. At 6 months 53 (67.9%) patients were in stable sinus rhythm and 18 (23%) out of those on antiarrhythmic drugs. At 6 months after ablation all parameters of LA size decreased statistically significant. Conclusions: In our first experience, endocardial catheter ablation results in significant conversion in sinus rhythm in patients with paroxysmal AF. The maintenance of stable sinus rhythm after abla-tion procedure determined a significant reverse LA remodeling, irrespective of parameter used for LA size assessment. The most relevant parameter for assessing reverse LA remodel-ing in patients with endocardial ablation of paroxysmal AF was LA volume by echocardiog-raphy.

References

1. Haissguerre M, Jais P, Shah D et al. Spontaneous initiation of atrial fibrillation by ectopic beats origi-nating in the pulmonary veins. N Engl J Med 1998; 339: 659-666.
2. ***2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design: A report of the Heart Rhythm So-ciety (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Europace 2012; 14: 528-606.
3. ***2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719-2747.
4. Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in chronically awake instrumented goats. Circulation 1995; 92(7): 1954-1968.
5. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the Euro-pean Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16(3): 233-270.
6. ***European Association of Echocardiography recommendations for standardization for perfor-mance, digital storage and reporting of echocardiographic studies. Eur J Echocardiography 2008; 9: 438.
7. Knackstedt C, Visser L, Plisiene J et al. Dilatation of the pulmonary veins in atrial fibrillation: a transesophageal echocardiographic evaluation. Pacing Clin Electrophysiol 2003; 26(6): 1371-1378.
8. Cosio FG, Castilio E. Left atrial Anatomic Remodeling in Atrial Fibrillation. J Cardio Electrophysiol 2007; 18: 53-54.
9. Bisbal F, Guiu E, Calvo N et al. Left atrial sphericity: a new method to assess atrial remodeling. Impact on the outcome of atrial fibrillation ablation. J Cardiovasc Electrophysiol 2013; 24: 752-759.
10. Kumagai K, Sakamoto T, Nakamura K, Hayano M, Yamashita E, Oshima S. Pre-procedural predic-tion of termination of persistent atrial fibrillation by catheter ablation as an indicator of reverse re-modeling of the left atrium. Circ J 2013; 77(6): 1416-1423.
11. Lo LW, Chen SA. Cardiac Remodeling After Atrial Fibrillation Ablation. J Atr Fibrillation 2013; 6(1): 877.

Additional Files

Published

2017-09-30

Issue

Vol. 121 No. 3 (2017): The Medical-Surgical Journal

Section

INTERNAL MEDICINE - PEDIATRICS

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