Positive left atrial remodeling in patients with paroxysmal atrial fibrillation after a successful radiofrequency pulmonary vein isolation.

Abstract

The potential relationship between the initial left atrial (LA) echocardiographic parameters and LA remodeling after pulmonary vein isolation with RF energy (PVI) with effectiveness of this treatment is discussed. To determine the influence of initial and after follow-up transthoracic echocardiography derived predictors of successful PVI in patients with paroxysmal atrial fibrillation (AF). 80 patients with paroxysmal AF (58 [interquartile range, IQR], 50-63] years, males: 58 [IQR, 50-63]), hospitalized for the first time PVI procedure were included. Before and after a minimum of 6 months of follow-up period a clinical and echocardiographic evaluation were performed. LA morphological parameters (diameter, volumes and other detailed LA parameters), as well as LA peak segmental and global longitudinal strains (PLS) and LA wall strain synchrony were assessed. In the whole group after a follow-up period, patients presented higher mean LA Volconduit. Patients with no AF recurrences had lower post-PVI LA volumes, higher LA ejection fraction and LA expansion index, when compared to the patients after ineffective PVI. Patients who maintained sinus rhythm after PVI procedure were characterized by a higher initial segmental strains: LA PLSbasal-inferior and PLSapical-septal, as well as higher LA wall strain dispersion in time. Some echocardiographic parameters related to LA morphology improve after successful PVI treatment. LA strains and wall strain dispersion in time are not related to LA remodeling after successful PVI procedure. However the baseline LA standard and novel echocardiographic parameters cannot be used as a remote evaluation of the effectiveness of the PVI procedure.