Evaluation of left atrial structure and function serial changes after circumferential pulmonary vein ablation for paroxysmal atrial fibrillation

AIM: To evaluate the left atrial structure and function serial changes after circumferential pulmonary vein ablation (CPVA) for paroxysmal atrial fibrillation. METHODS: Thirty-three patients with paroxysmal atrial fibrillation underwent CPVA guided by CARTO. Conventional echocardiography was performed 1-3 days before CPVA and 1, 3, 6 and 12 months after CPVA. Echocardiographic parameters including left atrial (LA) diameter, volume indicators, mitral peak A wave velocity (VA) and peak E-wave velocity (VE) were measured at rest during sinus rhythm. left atrial emptying fractions were calculated to analyze the left atrial structure and function serial changes before and after CPVA. RESULTS: CPVA was successfully performed in all 32 patients with paroxysmal atrial fibrillation and the 1-year cure rate was 82%. Compared with that 1-3 days pre-CPVA, LA diameter significantly increased ［(44±4)mm vs. (41±3)mm, P<0.01］ 1 month after CPVA and no significant differences were seen 3 months and 6 months after CPVA. One-year follow-up showed that LA diameter significantly decreased ［(40±3)mm vs. (41±3)mm, P<0.05］ compared with that pre-CPVA. Compared with that 1-3 days pre-CPVA, LA minimum volume significantly increased (P<0.05) and the indicators of LA pump function such as LA active emptying fraction and LA total emptying fraction significantly decreased (P<0.05) 1 month after CPVA. Three months after CPVA, these parameters returned to the pre-CPVA levels. VA after CPVA was lower than that pre-CPVA (P<0.05, P<0.01), whereas VE/VA 1 month after CPVA increased significantly (P<0.05, P<0.01) but VE/VA in the subsequent follow-up returned to the pre-CPVA level. CONCLUSION: CPVA for paroxysmal atrial fibrillation has some negative effects on recent LA structure and mechanical function with the increase in LA diameter and the decline in LA pump function. But these negative effects are relatively mild and reversible and will restore 3 months after CPVA. Long-term follow-up has demonstrated limited anti-remodeling of LA structure.