Left atrial scar burden in sinus rhythm differs from atrial fibrillation using automated voltage analysis during radiofrequency ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Mannion ◽  
SJ Lennon ◽  
A Kenny ◽  
U Boles
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
De Novo ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
Mitral Annulus ◽  
Scar Burden ◽  
Funding Sources ◽  
Anterior Posterior

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Scar burden in atrial fibrillation (AF) can be overestimated due to many factors. Scar burden has prognostic value and substrates considered for ablation by some electrophysiologists. We compared left atrial (LA) scar voltage in AF to sinus rhythm (SR) using voltage histogram analysis (VHA) of those undergoing pulmonary vein isolation (PVI) for persistent AF (PeAF). We believe this is the first study analysing LA scar location in SR and AF using VHA. Methods We retrospectively analysed 120 anatomical segments (AS) and whole LA voltages (N= 10 patients, mean age 68 ± 7, 4 females) in SR and AF. Fast anatomical maps (FAM) were grouped into 6 AS in AF and SR: Anterior, Posterior, Roof, Floor, Septal and Lateral AS, which were analysed via VHA (Figure 1) in 10 voltage ranges between 0mV-0.5mV. Total LA area in each voltage aliquot was recorded in SR and AF, taking diseased LA as 0.2-0.5mV and dense LA scar as <0.2mV. The pulmonary veins, mitral annulus and trans-septal puncture sites were excluded from analyses. We included patients over age 18 with PeAF who had de novo PVI with no extra ablation lines, maps with >1000 voltage points in both rhythms and uniform procedure involving initial mapping in AF then remapping in SR after PVI. Statistical analyses conducted with IBM SPSS v.26. Results Total LA scar burden was greater in AF (Mean 142.76 mm², SD ± 138.78mm²) than SR (Mean 109mm², SD ± 107.8mm²), p= <0.0001, Table 1. Scar correlation in SR and AF had a good relationship, R = 0.416 (p= <0.001). Every 1mm² of scar identified during SR yielded a mean of 1.54mm² in AF, (p= <0.001). Conclusions AF was associated with higher scar burden in the Roof, Anterior, Lateral and Posterior AS. Dense LA scar (≤ 0.2mV) on the Posterior AS was significantly higher in AF, while in other AS was comparable to SR. Mapping substrate in AF, especially the posterior wall, may be misleading as scar burden may be overestimated when compared to SR. Table 1Voltage< 0.02 mV (mean area ± SD mm2)0.2-0.5mV (mean area mm2)RhythmSRAFp-valueSRAFp-valueEntire LA115.89 ± 113.61143.41 ± 144.230.02*105.78 ± 103.73144.00 ± 135.24<0.0001*Roof82.72 ± 117.3283.68 ± 113.560.95115 ± 77.14150.61 ± 93.170.01*Anterior131.8 ± 169.53126.5 ± 154.570.85158.53 ± 99.22220.87 ± 173.070.002*Lateral70.5 ± 80.0090.57 ± 117.990.3687.52 ± 66.82137.05 ± 104.990.0002*Septal80.99 ± 89.0380.99 ± 89.030.6899.123 ± 73.62115.37 ± 84.830.18Floor105.1 ± 134.91106.42 ± 148.670.96117.62 ± 85.41151.2 ± 110.070.052Posterior102.14 ± 157.47159.03 ± 194.650.02*138.27 ± 112.28234 ± 150.45<0.0001*LA scar distribution in SR and AF, *denotes significant results.Abstract Figure 1

scholarly journals Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

2021 ◽  
Vol 10 (14) ◽  
pp. 3129
Author(s):  
Riyaz A. Kaba ◽  
Aziz Momin ◽  
John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cardiovascular Death ◽  
Good Effect ◽  
Complex Forms

Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A P Martin ◽  
M Fowler ◽  
N Lever
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
The Novel ◽  
Median Treatment

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated.  Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.

scholarly journals Natural History of Arrhythmia After Successful Isolation of Pulmonary Veins, Left Atrial Posterior Wall, and Superior Vena Cava in Patients With Paroxysmal Atrial Fibrillation: A Multi‐Center Experience

2021 ◽  
Author(s):  
Sanghamitra Mohanty ◽  
Chintan Trivedi ◽  
Pamela Horton ◽  
Domenico G. Della Rocca ◽  
Carola Gianni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Superior Vena Cava ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Posterior Wall ◽  
Left Atrial Posterior ◽  
Group 1

Background We evaluated long‐term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities. Methods and Results A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia‐free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidities); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10 years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3–8.5) and 5.6 (IQI 3.8–8.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147/201 and 414/456 received left atrial appendage and coronary sinus isolation and 54/201 and 42/456 had left atrial lines and flutter ablation. At 2 years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage/coronary sinus isolation remained arrhythmia‐free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation ( P <0.001). Conclusions Very late recurrence of atrial fibrillation after successful isolation of pulmonary veins, regardless of the comorbidity profile, was majorly driven by non‐pulmonary vein triggers and ablation of these foci resulted in high success rate. However, presence of comorbidities was associated with significantly earlier recurrence.

scholarly journals Spatial and quantitative assessment of the correlation between sinus rhythm and atrial fibrillation voltage mapping to identify low voltage substrate in persistent atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Nairn ◽  
C Nagel ◽  
B Mueller-Edenborn ◽  
H Lehrmann ◽  
A Jadidi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Low Voltage ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Shape Modelling ◽  
National Budget ◽  
Spatial Concordance ◽  
Public Grant

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG) through DO637/22-3 Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg through the Research Seed Capital (RiSC) program. Introduction Presence of left atrial (LA) fibrotic low voltage substrate (LVS) is associated with high risk for arrhythmia recurrences in patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation (AF). PVI and additional ablation of LVS - as identified by mapping in sinus rhythm (SR) or AF - has been reported to improve SR maintenance rates, despite differences of the extent and distribution of LA-LVS in SR versus AF.  Aims To study the relationship between SR and AF voltage maps, we sought to identify the optimal AF voltage threshold providing the highest concordance in the extent and distribution of LVS when comparing voltage maps in SR vs. AF. Methods Using the statistical shape modelling software Scalismo, the voltage information from the SR and AF maps (acquired prior to PVI) from 28 patients (66 ± 7 years, 46% male, 82% persistent AF) was projected onto a representative LA-geometry. Sensitivity and specificity of LVS identification were calculated for varying thresholds during AF and the correlation between the SR (threshold 0.5mV) and AF maps was assessed and areas of agreeing LVS classification (SR & AF) were identified for each patient. The data of all 28 patients were combined to a spatial histogram of agreement between SR and AF low voltage maps. Results  The correlation between SR and AF maps was high across all patients, with agreement at 60-95% of all mapped sites (Figure A: each red triangle represents one patient and the respective agreement of LVS classification and substrate extent).  The optimal AF threshold - to identify LA-LVS &lt;0.5 mV in SR - was 0.29 mV (Q1-3: 0.20-0.37 mV) and was independent of the underlying extent of LVS during SR (Figure A: each blue asterisk represents one patient and the corresponding AF threshold and substrate extent). Agreement between LVS in AF vs. SR was high across most (&gt;90) patients on the anterior LA, lateral LA and the left atrial appendage. Lower agreement (60% of patients) was observed in the posterior wall (Figure B). Conclusions SR and AF voltage maps reveal high spatial concordance in low voltage substrate at the anterior LA, lateral LA and LA appendage, however significant discordances in LVS are found in 40% of patients at the posterior LA. Further studies on an extended patient cohort should assess if regional voltage-thresholds would result in an improved substrate concordance between AF and SR substrate maps. Abstract Figure.

Abstract 14352: Staged Hybrid Atrial Fibrillation Ablation With Addition of Endoscopic Left Atrial Appendage Closure Reduces Arrhythmia Recurrence Between 3 and 12 Months Compared to Non-staged Hybrid Without Closure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David C Kress ◽  
Lynn Erickson ◽  
Ana C Perez Moreno ◽  
Imran Niazi ◽  
M. Eyman Mortada ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Hybrid Approach ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Atrial Appendage ◽  
Closure Device ◽  
Epicardial Ablation

Introduction: The hybrid, or convergent procedure, uses a minimally invasive combined epicardial/endocardial ablation approach for patients in persistent AF. In the staged hybrid approach, the electrophysiologist performs the endocardial ablation a minimum of 30 days after the surgeon performs epicardial ablation. Placement of a left atrial appendage (LAA) closure device (AtriCure AtriClip) has been shown to electrically isolate the LAA. Added to the scar formation on the posterior wall via epicardial ablation, it eliminates additional substrate in persistent atrial fibrillation (AF). Hypothesis: Patients with persistent AF who underwent a staged hybrid approach with thoracoscopic placement of the AtriClip may have less likelihood of arrhythmia recurrence between 3 and 12 months compared with those who underwent nonstaged hybrid ablations without use of the AtriClip. Methods: Patients in persistent or long-standing paroxysmal AF underwent ablation using either a staged hybrid approach with AtriClip (n=23) or a nonstaged hybrid approach without AtriClip (n=136). Groups were compared by running a t-test (mean±SD) or Wilcoxon rank sum [median, interquartile range (IQR)]. Categorical data were compared with Pearson’s chi-squared test. Results: Significantly fewer patients who had undergone a staged hybrid with AtriClip recurred with arrhythmia (2, 8.7%) compared to those with a nonstaged, no AtriClip approach (40, 29.4%) (p=0.04) between 3 and 12 months. The staged hybrid approach also had significantly fewer patients requiring cardioversion to restore sinus rhythm during the procedure (p<0.001). Conclusions: A staged hybrid approach with AtriClip placement reduced recurrent arrhythmia between 3 and 12 months compared to a nonstaged hybrid procedure without AtriClip. A benefit was also seen in a steep reduction in the need for cardioversion during the subsequent endocardial ablation to restore sinus rhythm.

Abstract 4655: Retrograde Ethanol Infusion in the Vein of Marshall for Ablation of Atrial Fibrillation: Tissue Ablation, Effects on Regional Vagal Innervation and First Human Experience

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Miguel Valderrábano ◽  
Harvey R Chen ◽  
Jasvinder S Sidhu ◽  
Liyun Rao ◽  
Yuesheng Ling ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Coronary Sinus ◽  
Left Atrial ◽  
Vagal Stimulation ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
Tissue Ablation ◽  
Ethanol Infusion ◽  
Before And After

The vein of Marshall (VOM) is an attractive target during ablation of atrial fibrillation due to its autonomic innervation and its location anterior to the left pulmonary veins and drainage in the coronary sinus. We studied 14 dogs. A coronary sinus venogram showed a VOM in 10, which was successfully cannulated with an angioplasty wire and a 2 mm balloon. In 5 dogs, electroanatomical (Carto) maps of the left atrium were performed at baseline and after ethanol (100%, 4 – 8 cc) was infused in the VOM, which demonstrated the creation of a new crescent-shaped scar in the left atrium, extending from the annular left atrium towards the posterior wall and left pulmonary veins. In 4 dogs, both cervical vagal trunks were isolated in the carotid sheath and cuff stimulation electrodes were attached to them. Effective refractory periods (ERP) were measured in 3 sites of the left atrium, before and after high-frequency bilateral vagal stimulation. The baseline ERP was 113.6±35.0 ms, and decreased to 82.2±25.4 ms (p<0.05) after vagal stimulation. After alcohol infusion in VOM, vagally-mediated ERP decrease was eliminated (from 108±27.2 ms to 95.6 ±16.7ms, p=NS). This elimination of vagal effects was not uniform and was limited in sites in proximity with the VOM (baseline ERP 105±18.7ms vs post vagal 98.±37.6ms, p=NS, as opposed to 106.7±27.1ms vs post vagal 73.3±19.7ms, p<0.05, in sites remote to VOM). We also tested feasibility of VOM alcohol infusion in humans: 2 patients undergoing pulmonary vein antral isolation had successful VOM cannulation: left atrial voltage maps demonstrated new scar involving the infero-posterior left atrial wall extending towards the left pulmonary veins. Retrograde alcohol infusion in the VOM achieves significant left atrial tissue ablation, abolishes local vagal responses and is feasible in humans.

Left-thoracoscopic Convergent ablation for atrial fibrillation

2020 ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Beating Heart ◽  
Thoracoscopic Approach ◽  
Occlusion Device ◽  
Left Atrial Posterior

Epicardial Convergent ablation followed by endocardial touch-up and an additional ablation may be superior to catheter-based interventions in patients with persistent atrial fibrillation. We sought to extend the epicardial lesion set by changing the standard subxiphoid thoracotomy to a left-lateral, totally thoracoscopic approach. This tutorial depicts a closed-chest, beating-heart procedure, including ablation of the left atrial posterior wall, the left atrial dome, and the left pulmonary veins. The left atrial appendage is closed using an epicardial occlusion device.

scholarly journals Recovery of conduction following high power short duration approach in radiofrequency catheter ablation for atrial fibrillation: a single-center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Short Duration ◽  
High Power ◽  
Left Atrial ◽  
Posterior Wall ◽  
Power Delivery ◽  
Maximum Temperature ◽  
Funding Sources ◽  
Single Center Experience ◽  
Left Atrial Posterior

Abstract Introduction High-power short-duration (HPSD) ablation is currently being adopted by many as the preferred procedural technique in atrial fibrillation (AF). However, the optimal duration of energy delivery to successfully create a durable lesion is not clear yet. Purpose We evaluated the association of electrical reconnection with lesion-duration in HPSD ablation. Methods Consecutive AF patients undergoing repeat procedure after a prior HPSD ablation with or without isolation of left atrial appendage (LAA) and coronary sinus (CS) were included in this analysis. HPSD ablation was defined as ablation with maximum temperature setting at 420C and power delivery at 45 W for 10–15 sec (5 seconds in the CS area and posterior wall near the esophagus). In some patients a mechanical esophageal deviation tool was used to deflect the esophagus away from the ablation site. Results A total of 2249 AF patients (with LAA and CS isolation: 1451; without LAA and CS isolation: 798) receiving redo ablation after a prior HPSD procedure were included in the analysis. At the prior procedure with the HPSD approach, mean duration of ablation was significantly shorter in the area facing the esophagus compared to elsewhere (5.2±1.5 vs 12.5±1.7 seconds, p&lt;0.001). Application duration was reduced to &lt;10 sec to avoid overheating and steam pops in 1221 (84%) patients receiving LAA and CS isolation. At the redo, recovery of conduction was noted in the CS (592, 40.8%), LAA (493, 34%), and PV and left atrial posterior wall (LAPW) (310, 13.8%). Of the 310 patients with LAPW reconnection, 91% (n=282) had the conduction recovered in the area facing the esophagus. In 73 patients, esophageal displacement device was used during the prior HPSD ablation. Average duration of ablation lesions in LAPW among those 73 patients was 9.2±2 seconds. PV-LAPW reconnection was observed in 3/73 (4.1%) patients. Conclusion HPSD ablation with lesion duration of &lt;10 sec was associated with conduction recovery in the LAA, CS and the LAPW area facing esophagus. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The impact of left atrial inferior wall isolation, in addition to pulmonary veins and left posterior wall, on long-standing persistent atrial fibrillation

2020 ◽  
Vol 6 (10) ◽  
pp. 702-705
Author(s):  
Rena Nakamura ◽  
Yasuteru Yamauchi ◽  
Kaoru Okishige ◽  
Manabu Kurabayashi ◽  
Masahiko Goya ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Inferior Wall ◽  
Left Posterior ◽  
The Impact

scholarly journals REMOdELLING OF THE LEFT ATRIAL AT THE PATIENTS WITH ATRIAL FIBRILLATION IN VARIOuS METHOdS OF SINuS RHYTHM RECOVERY

2017 ◽  
Vol 9 (2) ◽  
pp. 51-59
Author(s):  
T Y Gromyko ◽  
S A Sayganov
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Medical Therapy ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Tissue Doppler ◽  
Estimated Parameters ◽  
Reliable Parameter ◽  
Group 3 ◽  
Group 2

Aim. To compare features of straight and return remodeling of the left atrial (LA) at patients with atrial fibrillation (AF) at various options of sinus rhythm (SR) restoration depending of a choice of the cardioversion. Material and methods. We examined.153 patients with the nonvalvular AF lasting from24 hours to 6 months. All patients were divided in 3 groups. In group 1 (49 patients) SR was restored medically, in the group 2 (57 patients) SR was restored by means of electrical cardioversion (EC), in the group 3 (47 patients) underwent radio-frequency isolation of pulmonary veins (RFI PV). Echocardiog- raphy was performed to all patients at the time of AF, and also on 1, 3, 5, 15 days and in 6 months after recovery of SR with an assessment systolic and the diastolic function of left ventricle (LV), thickness of walls of a myocardium, the front and back size of the LA, volume of LA, and also design parameter of LA pressure (E\E’) by Tissue doppler visualization.Results. Index LA (ILA) authentically decreased at the patients, who are exposed to RFI PV, at preservation of SR compared with recurrence of AF for 6 months (р<0,05). In group of medical therapy index of volume LA (IVLA) initially it was authentically lower at patients with resistant SR for 6 months, compared with recurrence of AF (р<0,05). And also IVLA authentically decreased in group RFI PV without paroxysms of AF for 6 months (р<0,001). At the medical cardioversion LA pressure (E\E’) authentically decreased by 2 weeks (р<0,05) without paroxysms of AF and significantly didn't change by 6 months. While in the presence of paroxysms of AF for 6 months only the tendency to de- crease of this parameter was noted. And in group of RFI PV reliable dynamics of pressure in LA was recorded at patients without paroxysms of AF by 2 weeks (р<0,05) and by 6 months (р<0,05). While in the presence of paroxysms of AF this parameter significantly didn't change by 6 months. In the group of EC reliable dynamics of the estimated parameters of LA remodeling isn't detected.Conclusions. At patients with AF after cardioversion and without paroxysms of AF for 6 months LA sizes authentically decrease in group of medical therapy (IVLA, (р<0,05)) and at RFI PV (ILA, (р<0,05), IVLA (р<0,001)). LA pressure (E/E’) could be considered as a reliable parameter of the return remodeling of LA after cardioversion and without paroxysms of AF for 6 months in cases of medical therapy (р<0,05) and RFI PV (р<0,05).

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