5.2 Hemodynamics of LAA
Our data can provide pathophysiologic insight to the potential reduction of ischemic stroke after RFCA: a significant improvement of LAA flow volume after RFCA. In our RFCA cohort including both paroxysmal and non-paroxysmal AF patients, VENC-MRI was increased by 44% after RFCA. Rhythm theory and atrial cardiomyopathy theory are two major explanations for the increased risk of ischemic stroke in AF patients.2, 18 Although there are no concrete evidence that RFCA can reverse atrial cardiomyopathy, successful maintenance through RFCA will significantly improve the hemodynamics of LAA as demonstrated in this study. In our cohort, those without late recurrence had significantly greater improvement in VENC-MRI (∆VENC-MRI = 15.55 ± 41.41 vs. 25.75 ± 37.00; p = 0.016). Those with low VENC-MRI before RFCA also had greater improvements (∆VENC-MRI = 16.72 ± 38.39 vs. 50.64 ± 28.92; p < 0.001). Our results suggest successful maintenance of sinus rhythm thorough RFCA especially in those with limited LAA function at baseline can have significant positive impact on LAA hemodynamics. Whether this beneficial effect on LAA flow volume will lead to decrease in clinical ischemic stroke needs further investigation.