Introduction:
Atrial fibrillation (AF) is the most common supraventricular arrhythmia
in adult patients leading to increased morbidity and
mortality.1-2 AF begets AF resulting in electrical,
functional and structural alterations, summarized under the term
remodeling of the left atrium (LA).3-4 Pulmonary vein
isolation (PVI) is currently the treatment of choice for the maintenance
of sinus rhythm (SR) in patients suffering from paroxysmal and
persistent AF.5-8 Successful PVI leading to
sustainable SR results into reduction of the LA volume and alteration of
the LA geometry, a phenomenon known as LA
remodeling.9-12 However, there are limited data
regarding the remodeling of the LA in patients with recurrent AF after
PVI. The imaging modalities utilized currently for the assessment of LA
remodeling are transthoracic echocardiography (TTE), cardiac computed
tomography (cCT) and cardiac magnetic resonance tomography (CMR), which
is considered the current gold standard for LA volume estimation,
providing accurate endocardial border definition.13-15Alternatively, 3-dimensional rotational angiography (3D-RA) under rapid
right ventricular pacing immediately before PVI, allows the
3-dimensional reconstruction of the LA geometry with high accuracy in
real time, without dependency from the cardiac cycle. It has also the
unique advantage of high-quality resolution by exhausting the elastic
properties of the LA due to the direct and fast injection of radiopaque
contrast within a short period of very low intracavitary
pressures.16, 17 Nevertheless, 3D-RA is an invasive
procedure and can only be performed peri-interventionally during a
scheduled PVI. In the current study we sought to analyse the impact of
radiofrequency PVI on the LA geometry in patients, who underwent repeat
PVI after documented AF recurrence.