Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function: An echocardiography and cine computed tomography analysis

Atul Verma, Fethi Kilicaslan, James R. Adams, Steven Hao, Salwa Beheiry, Stephen Minor, Volkan Ozduran, Samy Claude Elayi, David O. Martin, Robert A. Schweikert, Walid Saliba, James D. Thomas, Mario J. Garcia, Allan Klein, Andrea Natale

Research output: Contribution to journalArticle

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Abstract

Left Atrial Function After PVAI. Background: Although pulmonary vein antrum isolation (PVAI) may cure atrial fibrillation (AF) and improve left atrial (LA) function, the effect of extensive LA ablation on LA function is not well known. Objective: To assess the impact of PVAI on LA function remotely postablation. Methods: Consecutive patients undergoing PVAI had either transthoracic (TTE) and transesophageal (TEE) echocardiography (n = 41) or cine EBCT (n = 26) performed preablation and 6 months postablation. Only patients with paroxysmal and persistent, but not permanent, AF were included. Imaging was done in sinus rhythm for all patients. LA diameter (LAD), LA systolic and diastolic areas, and left atrial fractional area change (LFAC) were assessed by TTE. Transmitral (TMF), left atrial appendage (LAA), and pulmonary venous (PVF) Doppler flows were measured by TEE. Peak A on TMF, LAA peak emptying velocity (LAAF), and peak A reversal (AR) on PVF were used as surrogates of LA contractile function. Peak S on PV flow was used as a surrogate of reservoir function. LA areas, volumes, and LA ejection fraction (LAEF) were measured from cine EBCT. Results: Mean radiofrequency ablation time was 45 ± 21 minutes. All four PVs were isolated for all patients; there were no cases of PV stenosis. Echocardiography revealed a significant reduction in LAD and LA areas post-PVAI. Both peak A and peak AR were also higher post, while other variables showed strong trends toward improvement. In the subset of patients with persistent AF, post-PVAI improvements were seen in LA size, peak A, and even peak S (P = 0.04). Cine EBCT showed a significant decrease in both LA areas and volumes post-PVAI. There was also a significant improvement in LAEF post-PVAI from 17 ± 6% to 22 ± 5% (P = 0.01). Conclusion: Extensive ablation during PVAI does not cause deterioration in LA function, and may cause long-term improvement, especially in patients with higher AF burden.

Original languageEnglish (US)
Pages (from-to)741-746
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number7
DOIs
StatePublished - Jul 2006
Externally publishedYes

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Left Atrial Function
Pulmonary Veins
Echocardiography
Tomography
Atrial Fibrillation
Atrial Appendage
Transesophageal Echocardiography
Pathologic Constriction

Keywords

  • Ablation
  • Atrial fibrillation
  • Function
  • Left atrium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function : An echocardiography and cine computed tomography analysis. / Verma, Atul; Kilicaslan, Fethi; Adams, James R.; Hao, Steven; Beheiry, Salwa; Minor, Stephen; Ozduran, Volkan; Claude Elayi, Samy; Martin, David O.; Schweikert, Robert A.; Saliba, Walid; Thomas, James D.; Garcia, Mario J.; Klein, Allan; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 17, No. 7, 07.2006, p. 741-746.

Research output: Contribution to journalArticle

Verma, A, Kilicaslan, F, Adams, JR, Hao, S, Beheiry, S, Minor, S, Ozduran, V, Claude Elayi, S, Martin, DO, Schweikert, RA, Saliba, W, Thomas, JD, Garcia, MJ, Klein, A & Natale, A 2006, 'Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function: An echocardiography and cine computed tomography analysis', Journal of Cardiovascular Electrophysiology, vol. 17, no. 7, pp. 741-746. https://doi.org/10.1111/j.1540-8167.2006.00488.x
Verma, Atul ; Kilicaslan, Fethi ; Adams, James R. ; Hao, Steven ; Beheiry, Salwa ; Minor, Stephen ; Ozduran, Volkan ; Claude Elayi, Samy ; Martin, David O. ; Schweikert, Robert A. ; Saliba, Walid ; Thomas, James D. ; Garcia, Mario J. ; Klein, Allan ; Natale, Andrea. / Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function : An echocardiography and cine computed tomography analysis. In: Journal of Cardiovascular Electrophysiology. 2006 ; Vol. 17, No. 7. pp. 741-746.
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abstract = "Left Atrial Function After PVAI. Background: Although pulmonary vein antrum isolation (PVAI) may cure atrial fibrillation (AF) and improve left atrial (LA) function, the effect of extensive LA ablation on LA function is not well known. Objective: To assess the impact of PVAI on LA function remotely postablation. Methods: Consecutive patients undergoing PVAI had either transthoracic (TTE) and transesophageal (TEE) echocardiography (n = 41) or cine EBCT (n = 26) performed preablation and 6 months postablation. Only patients with paroxysmal and persistent, but not permanent, AF were included. Imaging was done in sinus rhythm for all patients. LA diameter (LAD), LA systolic and diastolic areas, and left atrial fractional area change (LFAC) were assessed by TTE. Transmitral (TMF), left atrial appendage (LAA), and pulmonary venous (PVF) Doppler flows were measured by TEE. Peak A on TMF, LAA peak emptying velocity (LAAF), and peak A reversal (AR) on PVF were used as surrogates of LA contractile function. Peak S on PV flow was used as a surrogate of reservoir function. LA areas, volumes, and LA ejection fraction (LAEF) were measured from cine EBCT. Results: Mean radiofrequency ablation time was 45 ± 21 minutes. All four PVs were isolated for all patients; there were no cases of PV stenosis. Echocardiography revealed a significant reduction in LAD and LA areas post-PVAI. Both peak A and peak AR were also higher post, while other variables showed strong trends toward improvement. In the subset of patients with persistent AF, post-PVAI improvements were seen in LA size, peak A, and even peak S (P = 0.04). Cine EBCT showed a significant decrease in both LA areas and volumes post-PVAI. There was also a significant improvement in LAEF post-PVAI from 17 ± 6{\%} to 22 ± 5{\%} (P = 0.01). Conclusion: Extensive ablation during PVAI does not cause deterioration in LA function, and may cause long-term improvement, especially in patients with higher AF burden.",
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T1 - Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function

T2 - An echocardiography and cine computed tomography analysis

AU - Verma, Atul

AU - Kilicaslan, Fethi

AU - Adams, James R.

AU - Hao, Steven

AU - Beheiry, Salwa

AU - Minor, Stephen

AU - Ozduran, Volkan

AU - Claude Elayi, Samy

AU - Martin, David O.

AU - Schweikert, Robert A.

AU - Saliba, Walid

AU - Thomas, James D.

AU - Garcia, Mario J.

AU - Klein, Allan

AU - Natale, Andrea

PY - 2006/7

Y1 - 2006/7

N2 - Left Atrial Function After PVAI. Background: Although pulmonary vein antrum isolation (PVAI) may cure atrial fibrillation (AF) and improve left atrial (LA) function, the effect of extensive LA ablation on LA function is not well known. Objective: To assess the impact of PVAI on LA function remotely postablation. Methods: Consecutive patients undergoing PVAI had either transthoracic (TTE) and transesophageal (TEE) echocardiography (n = 41) or cine EBCT (n = 26) performed preablation and 6 months postablation. Only patients with paroxysmal and persistent, but not permanent, AF were included. Imaging was done in sinus rhythm for all patients. LA diameter (LAD), LA systolic and diastolic areas, and left atrial fractional area change (LFAC) were assessed by TTE. Transmitral (TMF), left atrial appendage (LAA), and pulmonary venous (PVF) Doppler flows were measured by TEE. Peak A on TMF, LAA peak emptying velocity (LAAF), and peak A reversal (AR) on PVF were used as surrogates of LA contractile function. Peak S on PV flow was used as a surrogate of reservoir function. LA areas, volumes, and LA ejection fraction (LAEF) were measured from cine EBCT. Results: Mean radiofrequency ablation time was 45 ± 21 minutes. All four PVs were isolated for all patients; there were no cases of PV stenosis. Echocardiography revealed a significant reduction in LAD and LA areas post-PVAI. Both peak A and peak AR were also higher post, while other variables showed strong trends toward improvement. In the subset of patients with persistent AF, post-PVAI improvements were seen in LA size, peak A, and even peak S (P = 0.04). Cine EBCT showed a significant decrease in both LA areas and volumes post-PVAI. There was also a significant improvement in LAEF post-PVAI from 17 ± 6% to 22 ± 5% (P = 0.01). Conclusion: Extensive ablation during PVAI does not cause deterioration in LA function, and may cause long-term improvement, especially in patients with higher AF burden.

AB - Left Atrial Function After PVAI. Background: Although pulmonary vein antrum isolation (PVAI) may cure atrial fibrillation (AF) and improve left atrial (LA) function, the effect of extensive LA ablation on LA function is not well known. Objective: To assess the impact of PVAI on LA function remotely postablation. Methods: Consecutive patients undergoing PVAI had either transthoracic (TTE) and transesophageal (TEE) echocardiography (n = 41) or cine EBCT (n = 26) performed preablation and 6 months postablation. Only patients with paroxysmal and persistent, but not permanent, AF were included. Imaging was done in sinus rhythm for all patients. LA diameter (LAD), LA systolic and diastolic areas, and left atrial fractional area change (LFAC) were assessed by TTE. Transmitral (TMF), left atrial appendage (LAA), and pulmonary venous (PVF) Doppler flows were measured by TEE. Peak A on TMF, LAA peak emptying velocity (LAAF), and peak A reversal (AR) on PVF were used as surrogates of LA contractile function. Peak S on PV flow was used as a surrogate of reservoir function. LA areas, volumes, and LA ejection fraction (LAEF) were measured from cine EBCT. Results: Mean radiofrequency ablation time was 45 ± 21 minutes. All four PVs were isolated for all patients; there were no cases of PV stenosis. Echocardiography revealed a significant reduction in LAD and LA areas post-PVAI. Both peak A and peak AR were also higher post, while other variables showed strong trends toward improvement. In the subset of patients with persistent AF, post-PVAI improvements were seen in LA size, peak A, and even peak S (P = 0.04). Cine EBCT showed a significant decrease in both LA areas and volumes post-PVAI. There was also a significant improvement in LAEF post-PVAI from 17 ± 6% to 22 ± 5% (P = 0.01). Conclusion: Extensive ablation during PVAI does not cause deterioration in LA function, and may cause long-term improvement, especially in patients with higher AF burden.

KW - Ablation

KW - Atrial fibrillation

KW - Function

KW - Left atrium

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