Nikki van Pouderoijen, Luuk H G A Hopman, Leontine E Wentrup, Joris R de Groot, Michiel J B Kemme, Cornelis P Allaart, Marco J W Götte
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引用次数: 0
Abstract
Background: Successful pulmonary vein isolation (PVI) promotes left atrial (LA) reverse remodeling, but its effect on right atrial (RA) remodeling remains unclear.
Objective: To study the impact of radiofrequency (RF) PVI on RA volumes and function in atrial fibrillation (AF) patients, assessed by cardiac MRI (CMR).
Methods: Forty-three AF patients (74.4% male, 61±7 years) undergoing first RF PVI, without atrial flutter ablation, underwent three CMR scans: pre-PVI, early (<72 hours), and 3 months post-PVI. Indexed atrial volumes (RAVImin/max, LAVImin/max) and function were derived from two- and four chamber cine images, with longitudinal atrial strain analyzed using feature tracking.
Results: Early post-PVI, RAVImin significantly decreased (28.7±10.3mL/m2 to 26.0±9.9mL/m2,p=0.03), while RA EF significantly increased (37.3±11.5% to 41.7±10.1%,p=0.03). At 3 months, both RAVImin and RAVImax showed significant further reductions compared to baseline (28.7±10.3mL/m2 to 24.8±8.8mL/m2,p=0.002; 45.2±11.8mL/m2 to 40.3±11.9mL/m2,p<0.001, respectively). During this period, RA functional improvement persisted, as evidenced by RA reservoir and contractile strain (16.2±4.1% to 18.9±3.6%,p=0.003; 6.6±2.6% to 8.3±2.8%,p=0.005, respectively). LA volumes remained unchanged early post-PVI, but at 3 months, LAVImax significantly decreased compared to baseline (46.1±13.0mL/m2 to 39.1±11.3mL/m2,p<0.001). LA function, demonstrated by reservoir and contractile strain, was significantly diminished early post-PVI, which persisted at 3 months compared with baseline (18.6±4.0% to 17.0±3.4%,p=0.04; 8.5±3.0% to 6.9±2.4%,p<0.01, respectively).
Conclusion: This study demonstrates that RF PVI results in reverse bi-atrial remodeling, with significant reductions observed in RA and LA volumes. RA function showed a significant improvement post-PVI, while LA function demonstrated a persistent impaired function at 3 months, possibly due to LA ablation scarring.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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