247 Doppler-echo evaluation of left atrial and ventricular function after circumferential RF catheter ablation of pulmonary veins due to paroxysmal and persistens atrial fibrillation. A prospective 5 m

Abstract

Background: Hemodynamics of isolated atrial fibrillation (AF) has not been widely investigated, but it is belived to be associated with slight enlargement of left atrial (LA) size and minor degree of left ventricular (LV) diastolic dysfunction, that is presumed rather to be a result than a cause of so called „lone AF”. Positive impact of sinus rhythm restoration by catheter ablation on LA size and LV function remains unclear. Aims: To evaluate the possible reverse remodeling of LV and LA after successful ablation procedure of AF and its relationship with arrhythmia recurrence in prospective 5 months follow-up study with transthoracal and transesophageal echocardiographic examination (TTE and TEE). Methods and results: Sixty two patients, with refractory to antiarrhyhtmic agents and highly symptomatic episodes of paroxysmal and persistent AF underwent circumferential pulmonary vein RF catheter ablation according to Pappone technique. 3-dimensional electroanatomic CARTO system was used. In all patients TTE and TEE was performed before and 5±3 months after procedure, in order to assess LA area and left atrial appendage (LAA) area and flow as well as certain systolic/diastolic LV function parameters (mitral flow A/E ratio, E-wave deceleration time, Tei index, ejection fraction). The influence of LA and LV function parameters change on maintenance of sinus rhythm was studied and conversely, the impact of sinus rhythm restoration on LA and LV function. Seventeen patients reported symptoms of arrhythmia, whereas 45 remained AF free. There were nether clinical nor echocardiographic baseline data determining ablation success rate. We found significant difference as far as LVEF was concerned before and after ablation procedure (62±3%, 64±4%; p<0.01), with no significance but still a positive trend (p=0.06) in a subgroup presenting with no arrhythmia recurrence at follow-up. We found evident correlation between certain, but not all LV systolic/diastolic parameters at the time of follow-up and the recurrence of arrhythmia. The most significant parameter for arrhythmia recurrence in our study was Tei index, that deteriorated significantly in patients with unsuccessful ablation. Conclusions: Five months follow-up after CPVI, with echo performance shows good clinical results, with significant improvement of some but not all LV systolic/diastolic function parameters.