Impact of Radiofrequency Ablation of Atrial Fibrillation on Pulmonary Vein Cross Sectional Area: Implications for the Diagnosis of Pulmonary Vein Stenosis

Jazayeri, Mohammad-Ali; Vanga, Subba Reddy; Vuddanda, Venkat; Turagam, Mohit K.; Parikh, Valay; Lavu, Madhav; Bommana, Sudharani; Atkins, Donita; Nath, Jayant; Rosamond, Thomas; Vacek, James L.; Reddy, Yeruva Madhu; Lakkireddy, Dhanunjaya

doi:10.4022/jafib.1531

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…In the first part of the present study, change from baseline to follow-up was compared between patients randomized to drug therapy versus ablation therapy. Consistent with previous studies, 7–13,17 patients with AF treated with catheter ablation therapy underwent reverse structural remodeling of the LA and all 4 PVs. In the current study; however, it was also demonstrated that patients randomized to ablation therapy underwent a significantly greater degree of reverse structural remodeling than patients randomized to drug therapy.…”

Section: Discussionsupporting

confidence: 89%

“…One study 16 found that LA dimensions significantly decreased in both patients with and without recurrences; however, the magnitude of change was larger in patients without recurrences. Another study 9 found that the reduction in PV ostial diameters was significantly greater in patients without recurrence than patients with recurrence; however, the difference in LA volume reduction was not significant. In the current study, the risk of both recurrence as well as other adverse clinical end points was assessed.…”

Section: Discussionmentioning

confidence: 91%

“…Consistent with this conceptual model, several previous studies have shown reverse structural remodeling following catheter ablation therapy. [7][8][9][10][11][12][13]17 To date, data are limited about remodeling in drug treated patients.…”

Section: Discussionmentioning

confidence: 99%

“…6 Following catheter ablation therapy, decreases in left atrial volume and PV diameters (reverse structural remodeling) have been observed. [7][8][9][10][11][12][13][14][15][16] The clinical consequences of reverse remodeling are not well defined, but some studies have reported that reverse remodeling is associated with decreased AF recurrence 10,12 and improved cardiac function. 10 While reverse remodeling after catheter ablation therapy has been shown in several previous studies, [7][8][9][10][11][12][13]17 none have compared the magnitude of reverse remodeling changes in ablation with an appropriately selected control group of patients treated with drug therapy.…”

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confidence: 99%

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Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy

Rettmann

Holmes²,

Monahan

et al. 2021

Circ: Arrhythmia and Electrophysiology

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Background - The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial was a randomized, prospective trial of left atrial catheter ablation versus drug therapy for treatment of atrial fibrillation (AF). As part of CABANA, a prospective imaging sub-study was conducted. The main objectives were to describe the patterns of changes in the dimensions of the left atrium (LA) and pulmonary veins (PVs), and the relationship between these changes with treatment assignment and clinical outcomes. Methods - CT or MRI was acquired at baseline and follow-up in 121 ablation (median follow-up 101 days) and 85 drug patients (median follow-up 97 days). Left atrial volume index (LAVI), mean PV ostial diameter (MPV) , and ostial diameters of each PV separately were computed. We examined the relationship between the change from baseline to follow-up with subsequent clinical outcomes (composite of death, disabling stroke, serious bleeding, or cardiac arrest [CABANA primary endpoint], total mortality or cardiovascular hospitalization, first AF recurrence after the 90 day blanking period, first AF/atrial flutter/ atrial tachycardia after the 90 day blanking period) using Cox proportional-hazards models. Results - The median (25 th , 75 th ) change from baseline for LAVI was -7.8 mL/m 2 (-16.4, 0.2), ablation arm and -3.5 mL/m 2 (-11.4, 2.6), drug therapy arm. The LAVI decreased in 52.9% of ablation patients versus 40.0% of drug therapy patients. Change for MPV was -2.7 mm (-4.2, -1.3) in the ablation arm versus -0.1 mm (-1.5, 0.8) in the drug therapy arm. Changes in LA and PV dimensions had no consistent relationship with the risk of developing the study primary endpoint. Reductions in LAVI, and in MPV diameter were associated with decreased risk of AF recurrence. Conclusions - Ablation patients demonstrated more frequent and larger atrial structural changes compared with drug patients. These changes suggest a critical relationship between structural features and AF generation.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy

Rettmann

Holmes²,

Monahan

et al. 2021

Circ: Arrhythmia and Electrophysiology

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“…First, we selected a given PV orifice and adjusted centerlines manually. The orifices were defined at the angle where the veins departed from the curvature of the LA [26] then we measured the areas and effective diameters perpendicular to the vessel wall based on the maximum and minimum diameter of the orifices [13]. In case of a left or right common trunk the measurements were carried out in the common ostium.…”

Section: Image Analysismentioning

confidence: 99%

The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation

Boussoussou

Szilveszter

Vattay

et al. 2022

Int J Cardiovasc Imaging

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Nowadays, a novel contact-force guided ablation technique is used for enclosing pulmonary veins in patients with atrial fibrillation (AF). We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions, as assessed by cardiac CT, could influence the success rate of first-pass pulmonary vein isolation (PVI). In a single-center, prospective study, we enrolled consecutive patients with symptomatic, drug-refractory AF who underwent initial radiofrequency catheter ablation using a modified CLOSE protocol. Pre-procedural CT was performed in all cases. Additionally, the diameter and area of the PV orifices were obtained. A total of 1034 LAWT measurements and 376 PV area measurements were performed in 94 patients (mean CHA2DS2-VASc score 2.1 ± 1.5, mean age 62.4 ± 12.6 years, 39.5% female, 38.3% persistent AF). Mean procedure time was 81.2 ± 19.3 min. Complete isolation of all PVs was achieved in 100% of patients. First-pass isolation rate was 76% and 71% for the right-sided PVs and the left-sided PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first-pass isolation. LAWT (mean of 11 regions or separately) had no effect on the acute procedural outcome on logistic regression analysis (all p ≥ 0.05). Out of all assessed parameters, only RSPV diameter was associated with a higher rate of successful right-sided first pass isolation (OR 1.01, p = 0.04). Left atrial wall thickness does not have an influence on the acute procedural success of PVI using ablation index and a standardized ablation protocol. RSPV diameter could influence the probability of right sided first-pass isolation.

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Relationship between the time point of left atrial size change and the outcomes of radiofrequency catheter ablation

Pan

et al. 2022

J Interv Card Electrophysiol

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Impact of Radiofrequency Ablation of Atrial Fibrillation on Pulmonary Vein Cross Sectional Area: Implications for the Diagnosis of Pulmonary Vein Stenosis

Cited by 3 publications

References 23 publications

Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy

Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy

The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation

Relationship between the time point of left atrial size change and the outcomes of radiofrequency catheter ablation

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