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.