Left atrial function after epicardial pulmonary vein isolation in patients with atrial fibrillation

Abstract

PurposeEpicardial pulmonary vein isolation has become an increasingly used therapy for medically resistant atrial fibrillation. The purpose of the present study was therefore to evaluate if epicardial pulmonary vein isolation combined with ganglionated plexi ablation affects the size and mechanical function of the left atrium, and whether the effects are dependent on the extensiveness of the ablation applications.MethodsA total of 42 patients underwent an echocardiographic examination prior to and 6 months after a minimal invasive epicardial pulmonary vein isolation procedure for the assessment of the effects on left atrial size and function. In 27 patients, who had sinus rhythm both at baseline and follow-up, was a comparison of atrial size and function possible at these time intervals. Fractional area changes were obtained from the left atrial end-systolic and end-diastolic areas in the apical four-chamber view. Pulsed-Doppler was used to assess the transmitral flow velocities to evaluate mechanical function.ResultsLeft atrial size and function at 6-month follow-up had not changed significantly from those at baseline as indicated by left atrial maximal area (17.1 ± 4.6 vs. 18.7 ± 5.3, p = 0.118), minimal area (12.5 ± 3.8 vs. 13.4 ± 4.7, p = 0.248), fractional area change (27.4 ± 8.2 vs. 28.7 ± 10.6, p = 0.670), and E/A ratio (1.49 ± 0.47 vs. 1.54 ± 0.67, p = 0.855).ConclusionsRadiofrequency ablation for epicardial pulmonary vein isolation combined with ganglionated plexi ablation has no major effects on atrial function or size. A preserved atrial function for those maintaining sinus rhythm may have important implications for thromboembolic risk after surgery, but warrants confirmation in larger trials.

Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation

“…Additionally, the maximum R-R interval is significantly longer in AF patients after high frequency stimulation (HFS), when compared to non-AF groups [ 83 ]. Active GP areas are more prevalent on the right side of the PVs, with no considerable difference observed between paroxysmal, persistent and long-standing persistent AF patients [ 84 , 85 , 86 , 87 ] ( Table 1 ). Ablation of active GPs on the right side of the PVs resulted in 92% sinus rhythm maintenance in patients at three month follow-up [ 86 ].…”