Abstract:
Introduction: We sought to investigate the net effect of
wide area circumferential radiofrequency catheter ablation (WACA) on
left atrial (LA) geometry.
Methods and results: Seventy-one patients, who underwent
a second PVI procedure, after index procedure of point-by-point WACA,
for recurrent paroxysmal (n=31) or persistent (n=40) atrial fibrillation
(AF) in our center were included. A three-dimension rotational
angiography of the left atrium (3D-RA) under rapid ventricular pacing
was performed immediately before ablation, at index and repeat ablation
in all patients. LA geometry in terms of volume, sphericity and surface
were assessed in all patients between first and second PVI.
There was a statistical significant reduction of the LA volume (65,6 ±
14 ml/m2 vs 62,2 ± 15 ml/m2,
p<0,001) and of the surface of the LA (74,4 ± 11,2 vs 70,4 ±
11,2 cm2/m2, p<0,001),
whereas the sphericity of the LA increased significantly (82 ± 2% vs.
83 ± 2%, p=0,004) in all 71 patients. Patients with paroxysmal AF
showed significant decrease of the LA volume (121,8 ± 25,7 vs 116 ± 32
ml, p=0,008) and increase of the LA sphericity (82,3 ± 2,1 vs 83,1 ±
2%, p=0,009). Patients with persistent AF showed significant decrease
of the LA volume (133,5 ± 32 vs 126 ± 32 ml, p=0,005), but only a trend
towards increased sphericity (82,4 ± 2,8 vs 83 ± 2,4%, p=ns).
Conlusions: WACA results into significant reduction of
the LA volume, LA surface area and into significant increase of the LA
sphericity in treated patients with recurrent AF.