Ablation of atrial fibrillation beyond pulmonary vein isolation: Do additional ablation lesions impact left atrial function?

Abstract

Introduction: Electrical isolation of pulmonary veins (PVI) is a cornerstone for atrial fibrillation (AF) ablation. The overall effect of AF ablation, and especially lesions beyond PVI, on left atrial (LA) function is currently poorly understood. Our aim was to determine if LA function is different in patients after extensive LA ablation compared to PVI only.We performed non-inferiority analysis of LA function after PVI with additional nonpulmonary vein ablation lesions in LA (PVI+) and PVI alone. Methods:We studied 68 patients consecutive patients who underwent AF ablation and who had complete transthoracic echocardiogram (TTE) within 12 months before AF ablation and 1−12 months after the procedure. Patients were stratified into two groups: PVI only and PVI+. Primary outcome was change in LA reservoir strain (LASr). Noninferiority margin was defined at 6%. Results:The PVI only group had a higher proportion of patients with paroxysmal AF (70% vs. 30%). The PVI+ group was observed to have a slightly higher increase in LASr compared to PVI alone (5.0% vs. 4.3%, p < .01 for noninferiority). LASr noninferiority was confirmed when adjusted for age, sex, coronary artery disease, hyperlipidemia, and AF type, rhythm at preprocedure TTE in a multivariable linear regression model, 90% CI (−5.46 to 2.04), p < .01. Conclusion:LA functional improvement evaluated by LASr was noninferior after PVI with additional LA ablation lesions compared to PVI alone. These findings were confirmed when adjusted for confounding clinical variables, suggesting that more extensive ablation does not negatively affect LA function.

No or little negative impact of ablation targeting non‐PV Triggers on left atrial strain: Can restoration of sinus rhythm and reversal of functional remodeling stand side by side?

“…5,6 Importantly, this strategy was less extensive and was suggested to lead to less scar formation than linear ablation and/or ablation of CFAEs. In this issue of the Journal of Cardiovascular Electrophysiology, Reynbahk et al 7 report an interesting study investigating the difference in LA functional remodeling and its reversal post ablation between PV isolation (PVI) alone and PVI plus non-PV trigger ablation strategies. A novel parameter, LA strain (reservoir strain), measured before and after ablation was used to assess LA function over time.…”