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| Impact of quantitative ablation on cardiac structure and function in patients with paroxysmal atrial fibrillation |
| HU Mingsheng, WANG Xiaofei, ZOU Cao, WANG Wenli, LIN Jia, LI Xun |
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Abstract Objective To investigate the changes of cardiac structure and function in patients with paroxysmal atrial fibrillation(PAF) after undergoing quantitative radiofrequency catheter ablation (RFCA). Methods We retrospectively analyzed the clinical data and postoperative followup data of 188 PAF patients after undergoing RFCA. All the subjects had been performed pointbypoint radiofrequency ablation, guided by the Visitag module of the Carto3 system in 64 cases and ablation index in 124 cases, respectively. The subjects were divided into recurrence group(n=31) and non-recurrence group (n=157). The recurrence of atrial fibrillation was defined as the appearance of rapid atrial arrhythmias including atrial tachycardia lasting over 30 s, atrial flutter and atrial fibrillation after a 3month blanking period. Echocardiography examination was utilized in measuring the atrial and ventricular diameter, and left ventricular systolic and diastolic function indexes before and 3 months after RFCA. Results (ⅰ) After an average followup period of (14.4±8.3) months, 83.5%(157/188) of patients maintained sinus rhythm. The success rate in PAF patients with the left atrial diameter (LAD)<40 mm and LAD≥40 mm is 89.1%(57/64) and 80.6%(100/124), respectively. (ⅱ) In the nonrecurrence group, LAD, the right atrial diameter (RAD) and bicuspid valve E wave velocity all significantly decrease after the operation (P<0.05). In the recurrence group, RAD significantly decreases while left ventricular ejection fraction (LVEF) significantly increases after the operation (P<0.05). There is no statistically significant difference of other indexes between the two groups. (ⅲ) Among the PAF patients with LAD≥40 mm, the indexes of LAD, RAD, LVEDD, LVESD,bicuspid valve E peak, and tricuspid regurgitation pressure are significantly higher than those PAF patients with LAD<40 mm before the ablation; LVEF is significantly reduced (P<0.05). Among the PAF patients with LAD<40 mm, RAD and bicuspid valve A peak significantly decrease after the ablation (P<0.05); among the PAF patients with LAD≥40 mm, LAD, RAD and bicuspid valve E peak decrease after the ablation while LVEF significantly increases (P<0.05). Conclusion The medium and longterm success rate of quantitative ablation is relatively high in PAF patients. Quantitative ablation could partially reverse both left and right atrial structural remodeling, and improve ventricular function.
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