Clinical Study Of Radiofrequency Ablation On Left Atrial Function In Patients With Persistent Atrial Fibrillation

Objective:To evaluate the left atrial strain and function using speckle tracking imaging (STI) in patients undergoing radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation.Methods:Thirty patients with persistent atrial fibrillation undergoing RFCA were followed up for 6-12 months. Left atrial strain and functional parameters on STI were compared, including left arial strains of segments and globle strain.Twenty healthy were chosen as control.Results:Compared with the control group, either the systolic strain or diastolic strain of LA was lower (-9.3±4.8 vs -4.2±3.4 P=0.000; 24.1±5.6 vs 16.5±7.8 P=0.000) in persistent AF. Compared with patients without recurrence of AF after RFCA, the LA strains during contraction and diastole in patients with AF recurrence were lower (-2.9 ± 4.1 vs -6.8 ± 4.5 P=0.037;10.5 ± 6.9 vs 17.8 ± 8.7 P=0.025), and LA strains decreased after RFCA (-2.7 ± 3.8 vs-2.9 ± 4.1 P=0.278; 8.6 ± 6.3 vs 10.5 ± 6.9 P=0.313). While the global strains of LA in patients without recurrence of AF improved significantly after RFCA (-8.9 ± 4.1 vs -6.8 ± 4.5 P=0.049; 21.7 ± 7.1 vs 17.8 ± 8.7 P=0.048).Compared with preoperative, in the patients without recurrence of AF the strains of basal and middle segments of septal wall and the basal segment of lateral wall increased after 6 months, while the strain of the other segments did not increase significantly.In patients with recurrence of AF,the strains during LA contraction and diastole all decreased in lateral and septal wall after procedure.Conclusions:STI could obtain strain of LA, and that provide special data about the function of LA, and successfully RFCA could lead to increase of LA strain.Objective:To evaluate the left atrial volume and function using real-time three-dimensional echocardiography (RT-3DE) in patients undergoing radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation.Methods:Twenty-eight patients with persistent atrial fibrillation undergoing RFCA were followed up for 6-12 months. Left atrial volume and functional parameters on RT-3DE were compared, including the internal diameter (LAD), the maximum volume (LAVmax), the minimal volume (LAVmin), and the left atrial ejection fraction (LAEF). Twenty healthy were chosen as control.Results:Compared with the control,the LAVmax(48.9±4.5 vs 38.6±4.1 P=0.000)、 LAVmaxI(33.8±4.9 vs 27.9±6.2 P=0.001), LAVmin(20.4±3.9 vs 14.5±4.3 P=0.000)、 LAVminI(15.9±4.1 vs 12.8±4.8 P=0.000) increased in persistent AF. But LAEF (50.2±7.6 vs 54.3±7.8 P=0.038) in persistent AF decreased.Compared with preoperative, in the patients without recurrence of AF, the LAVmax(40.3±5.1 vs 45.5±4.3 P=0.000), LAVmaxI(30.1±5.3 vs 31.2±4.8 P=0.23)、LAVmin(16.8±4.6 vs 19.7±3.9 P=0.013、LAVminI(13.2±4.3 vs 15.3±4.1 P=0.049) decreased and LAEF(53.1±8.9 vs 51.5±7.3 P=0.254) increased after 6 months,while in patients with recurrence of AF, the LAVmax(56.1±4.1 vs 52.6±5.8 P=0.15)、LAVmaxI(44.2±3.8 vs 39.2±5.4 P=0.063)、LAVmin(27.5±5.6 vs 24.5±4.3 P=0.183)、LAVminI(22.3±4.9 vs 19.8±5.3 P=0.228) increased and LAEF(42.2±5.6 vs 48.5±7.5 P=0.076) decreased after procedure.Sub-team analysis showed that the LAVmax、LAVmaxI、 LAVmin、 LAVminI were smaller in patients without recurrency of AF than those with recurrency.Conclusions:RT-3DE can demonstrate the improvement in structure and function of left atrium, and successfully RFCA could lead to LA reverse remodeling.Objective:Radiofrequency catheter ablation (RFCA) was a new treatment option for patients with atrial fibrillation (AF).But the effects of RFCA on left atrial (LA) size, volumes, and function in patients who undergo RFCA are not well understood.we aimed to systematiclly review the effect of RFCA on LA size, volumes and function in patients with AF.Methods:We searched MEDLINE、EMBASE、ScienceDirec、Highwire、Cochrane Central Register of Controlled trials、Cochrane database of systematic reviews and the reference lists of retrieved reports in July 2012.Studies conducted in patients with AF were included if the primary outcomes of the researches were changes of LA size or volumes and/or function after RFCA. Mean differences for changes of LA diameter (LAD), LA maximum volume (LAVmax), LA minimum volume (LAVmin),LA ejection fraction(LAEF),LA active emptying fraction(LAAEF) and LA strain were estimated using fixed-effects and random-effects meta-analyses.Results:Twenty six studies (enrolling 1821 patients) were included in the final analysis. Compared to preablation values, there were significant decreases in LA diameter and LA volumes at postablation follow-up. However, compared to preablation values, there were no significant differences in LA ejection fraction/LA active emptying fraction and LA strain at postablation follow-up.Decreases in LA diameter and LA volumes remained significant in those without AF recurrence but not in those with AF recurrence. LA ejection fraction/LA active emptying fraction did not decrease in patients without AF recurrence, whereas they decreased in patients with AF recurrence.As for LA strain,it seems that LA strain increases in patients without AF recurrence,with less fibrosis and with more LA volumes decrease,but the differences were not significant.Conclusions:Successful RFCA in patients with AF significantly decreases LA size and volumes, and does not seem to adversely affect LA function.