The Impact of Radiofrequency Wide Circumferential Pulmonary Vein Isolation on Left Atrial Geometry in Patients with Recurrent Atrial Fibrillation

Abstract

Purpose: The aim of the study was to investigate the effect of wide area circumferential radiofrequency catheter ablation (WACA) pulmonary vein isolation on left atrium (LA) geometry. Methods: Seventy-one patients underwent WACA, for recurrent paroxysmal ( n = 31) and persistent ( n = 40) atrial fibrillation (AF). A three-dimension rotational angiography of the LA was obtained immediately prior to index and repeat procedure. Results: Significant reduction of LA volume (65.6 ± 14 mL/m² vs. 62.2 ± 15 mL/m², p < 0.001) and surface (74.4 ± 11.2 vs. 70.4 ± 11.2 cm²/m², p < 0.001) was noted. LA sphericity increased significantly (82 ± 2% vs. 83 ± 2%, p = 0.004) in all 71 patients. Patients with paroxysmal AF showed significant reduction of LA volume (121.8 ± 25.7 vs. 116 ± 32 mL, p = 0.008) and increase of LA sphericity (82.3 ± 2.1 vs. 83.1 ± 2%, p = 0.009). Patients with persistent AF showed significant decrease of LA volume (133.5 ± 32 vs. 126 ± 32 mL, p = 0.005) and LA surface area (76.3 ± 12.3 vs. 71.8 ± 12.4 cm²/m², p = 0.005). LA sphericity (82.4 ± 2.8 vs. 83 ± 2.4%, p = ns) remained unchanged. Conclusions: WACA results into significant reduction of LA volume and surface area. Increased LA sphericity is observed in paroxysmal AF only.