Effects of different ablation strategies on long-term left atrial function in patients with paroxysmal atrial fibrillation: a single-blind randomized controlled trial

Abstract

Restoration of sinus rhythm in atrial fibrillation (AF) by radiofrequency catheter ablation (RFCA) is associated with a transient stunning of left atrial (LA) function. However, the long-term effects of different ablation strategies on LA function remain undetermined. We performed randomized controlled trial to evaluate the effects of RFCA, cryoablation, and 3D mapping-guided cryoablation on LA function of proximal AF patients within 1 year. The 3D mapping-guided cryoablation was defined as a maximum of two cryoablation procedures for each pulmonary vein accompanied by RFCA for additional points until complete pulmonary vein isolation was achieved. Conventional and speckle tracking echocardiographic analyses were performed to evaluate LA function. Among the 210 patients (70 in each group) included, a trend of decreasing LA systolic and diastolic function was observed in all groups, as evidenced by decreases in peak A-wave velocity, the global LA peak systolic strain, the peak strain rate, the peak early diastolic strain rate, and the peak late diastolic strain rate within 7 days to 3 months after ablation followed by gradual recovery thereafter. However, the temporal changes in the above four strain parameters among the three groups did not differ significantly within 1 year after ablation (all p > 0.05). Parameters of the LA emptying fraction and LA dimensions were not significantly affected. These results suggested that stunning of LA function occurred within 7 days to 3 months after ablation, and different strategies of AF ablation did not differentially affect the temporal changes in LA function up to 1 year after ablation.

Post Procedural Peak Left Atrial Contraction Strain Predicts Recurrence of Arrhythmia After Catheter Ablation of Atrial Fibrillation

“…Ablation may also affect autonomic nerve circuits involved in volume modulation of the LA, impairing LA reservoir function [28]. Second, ablation causes LA stunning in > 70% of patients, resulting in decreased contractile and reservoir function [29][30][31][32]. The decreased PACS at 1 day and LAEF in our group is consistent with impaired LA function post ablation, either through direct injury or stunning.…”

Post Procedural Peak Left Atrial Contraction Strain Predicts Recurrence of Arrhythmia after Catheter Ablation of Atrial Fibrillation

“…Ablation may also affect autonomic nerve circuits involved in volume modulation of the LA, impairing LA reservoir function [ 28 ]. Second, ablation causes LA stunning in > 70% of patients, resulting in decreased contractile and reservoir function [ 29 – 32 ]. The decreased PACS at 1 day and LAEF in our group is consistent with impaired LA function post ablation, either through direct injury or stunning.…”

Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

“…Thus, regular checkups may allow for clinicians to manage arrhythmia progression in advance and improve AF treatment. Future work will focus on how different ablation sources may affect the different studied parameters [ 42 , 43 ], and will prospectively analyze how previous AF burden affects ablation outcome [ 3 ] with a larger cohort of patients.…”