Left Atrial Function After Radiofrequency Catheter Ablation of Atrial Fibrillation　– Can Pre-Ablation Function Predict Contractile Improvement During Follow-up? –

Abstract

2576ANTOLINI M et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp dent predictor of LA function improvement at follow-up, but previous studies have not identified a cut-off of LA function able to predict LA functional recovery. 8 The aim of this mono-center prospective study was therefore to clarify the effect of AF ablation on LA function according to baseline atrial performance. Methods Patient EnrollmentFrom March to December 2013, all consecutive patients who underwent catheter ablation for paroxysmal or persistent AF in the electrophysiology laboratory were considered for enrollment. Only those who presented in sinus rhythm at baseline adiofrequency catheter ablation (RFCA) is an effective treatment in rhythm-control therapy for atrial fibrillation (AF), with a reduction in AF recurrence ranging from 50 to 80%. 1-3 By promoting a reduction in arrhythmic burden, RFCA improves symptoms and quality of life. 4,5Despite both structural and functional changes after RFCA having been extensively studied, the effect of AF ablation on left atrial (LA) function has not yet been sufficiently determined and remains a pivotal topic also with regard to the consequences of decision on whether to discontinue anticoagulation after successful ablation. 6 In patients with impaired LA function, the risk of thrombus formation is potentially augmented, irrespective of the classical risk factors. 7Pre-ablation LA function has been identified as an indepen- Background: Data are lacking on the effect of radiofrequency catheter ablation (RFCA) on atrial function. The aim of this study was to determine a cut-off of pre-ablation left atrial (LA) function in order to predict atrial functional recovery after RFCA. R

Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study)

“…While LA function or volume are not taken into account in traditional clinical risk scores for thromboembolism, there is pathophysiological evidence that an impaired LAEF in the setting of high LA volumes may promote blood stasis and hence thrombus formation . LAEF has been shown to predict acute embolism in AFib patients independently of age and sex .…”

“…Further insight in the significance of echo‐derived parameters of LA and ventricular function is expected from the ongoing “EACVI AFib Echo Europe Registry,” which aims to correlate such indices with thromboembolic risk in patients with AFib . Moreover, LAEF has been associated with AFib ablation outcomes and baseline LAEF has been reported to independently predict LAEF improvement or AFib recurrences after RF ablation.…”

“…It is noteworthy that two‐dimensional echocardiography, RT3DE, computed tomography and cardiac magnetic resonance have all been utilized in studies for this purpose. LAEF preservation, deterioration or improvement in distinct subgroups (based on baseline atrial function or on AFib recurrence) after pulmonary vein isolation have been reported. The intrinsic dissimilarities of different imaging approaches along with potential methodological issues (for instance, heart rhythm at the time of measurement acquisition) may be responsible for the contradictory findings .…”

“…LAEF preservation, deterioration or improvement in distinct subgroups (based on baseline atrial function or on AFib recurrence) after pulmonary vein isolation have been reported. The intrinsic dissimilarities of different imaging approaches along with potential methodological issues (for instance, heart rhythm at the time of measurement acquisition) may be responsible for the contradictory findings . Remarkably, most of these studies used relatively small sample sizes.…”

Echocardiographic assessment in patients with atrial fibrillation (AF) and normal systolic left ventricular function before and after catheter ablation: If AF begets AF, does pulmonary vein isolation terminate the vicious circle?

“…There are still discrepancies regarding available data concerning LA function recovery after AF ablation [15,[17][18][19]. This inconsistency is probably the result of a variety of LA function parameters used in different studies, divergent timelines, diverse imaging techniques and finally LA measurements analyzed during AF or SR.…”