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Blood Flow Volume of Left Atrial Appendage Measured by Magnetic Resonance Imaging is Improved after Radiofrequency Catheter Ablation of Atrial Fibrillation
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  • Yun Gi Kim,
  • Kyongjin Min,
  • Sung Ho Hwang,
  • Jaemin Shim,
  • Yun Young Choi,
  • Ha Young Choi,
  • Jong-Il Choi,
  • Yu-Whan Oh,
  • Young-Hoon Kim
Yun Gi Kim
Korea University Anam Hospital
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Kyongjin Min
Korea University - Anam Campus
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Sung Ho Hwang
Korea University Medical Center
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Jaemin Shim
Korea University - Anam Campus
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Yun Young Choi
Korea University Anam Hospital
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Ha Young Choi
Korea University Medical Center
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Jong-Il Choi
Korea University Medical Center
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Yu-Whan Oh
Korea University - Anam Campus
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Young-Hoon Kim
Korea University Medical Centrer
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Abstract

Introduction: Hemodynamics of left atrial appendage (LAA) is an important factor for future risk of ischemic stroke in atrial fibrillation (AF) patients and velocity encoded cardiac magnetic resonance imaging (VENC-MRI) can evaluate blood flow volume of LAA without any invasive procedures. We aimed to evaluate the impact of radiofrequency catheter ablation (RFCA) on LAA hemodynamics via MRI evaluation. Methods and Results: Consecutive RFCA cases in a single arrhythmia center were retrospectively analyzed. A total of 3,120 AF patients who underwent first RFCA were analyzed. Among these patients 360 patients had both pre- and post-RFCA VENC-MRI evaluation. Atrial fibrillation was non-paroxysmal in 174 (48.3%) patients. Mean VENC-MRI (ml/sec) was significantly improved after RFCA with 49.75±32.97 and 71.92±34.94 for pre- and post-RFCA, respectively. Patients with non-paroxysmal AF (∆VENC-MRI = 29.71±35.30 vs. 14.42±40.94; p < 0.001) and low pre-RFCA VENC-MRI (∆VENC-MRI = 50.64±28.92 vs. 16.72±38.39; p < 0.001) had significantly higher improvement in VENC-MRI. Those who experienced late recurrence before post-RFCA MRI had significantly less improvement in LAA flow volume (∆VENC-MRI = 15.55±41.41 vs. 25.75±37.00; p = 0.016). Similar results were obtained after adjusting covariates. Conclusions: Radiofrequency catheter ablation can significantly improve hemodynamics of LAA in AF patients. The beneficial effects were most prominent in non-paroxysmal AF, those who had low pre-RFCA VENC-MRI, and those without late recurrence. Whether the improved hemodynamics of LAA after RFCA actually leads to reduced risk of ischemic stroke should be evaluated in future trials.

Peer review status:UNDER REVIEW

21 Aug 2020Submitted to Journal of Cardiovascular Electrophysiology
24 Aug 2020Assigned to Editor
24 Aug 2020Submission Checks Completed
24 Aug 2020Reviewer(s) Assigned