Abstract
Introduction
The effect of circumferential pulmonary vein isolation (PVI) for atrial fibrillation (AF) on left atrial (LA) function has not been well defined.
Purpose
The aim of this study was to evaluate the immediate impact of ablation on parameters of global and regional LA function using intracardiac echocardiography (ICE)
Methods
We studied 26 consecutive patients (age 56±10 years, 19 men) with paroxysmal AF using ICE before and immediately after circumferential PVI. All pulmonary veins were isolated in all patients. ICE measurements included LA fractional area shortening, peak A wave on transmitral Doppler flow, peak emptying velocity on the left atrial appendage (LAA) Doppler flow, as well as tissue Doppler myocardial velocities at the level of the posterior LA wall, interatrial septum, and lateral wall, which were used as parameters of regional LA function.
Results
The mean radiofrequency ablation time was 37±22min. Post ablation there was a significant reduction of the LA fractional area shortening from 27±8% to 22±6% (p<0.01). The tissue Doppler velocity of atrial contraction at the posterior wall decreased significantly post ablation: from 8.9±1.8 cm/s to 6.9±1.4 cm/s (p<0.01). There were no significant differences between the pre and post ablation values for tissue Doppler velocities at the level of the interatrial septum or LA lateral wall. The post ablation peak transmitral A wave and peak LAA Doppler velocities did not differ significantly from the pre ablation values.
Conclusion
In patients with paroxysmal atrial fibrillation, circumferential PVI results in an immediate decrease in LA function without a significant change in LAA function.
Left atrial dyssynchrony time measured by tissue Doppler imaging to predict atrial fibrillation recurrences after pulmonary vein isolation:Is this a mirage or the panacea?
