Effect of pulmonary vein isolation on left atrial appendage flow in paroxysmal atrial fibrillation

Background

Left atrial appendage (LAA) functional modification in the context of pulmonary vein isolation has been a focus point of research and LAA emptying flow velocity (LAAEFV) is considered to reflect LAA contractility, stunning, and fibrosis.

Objective

In the present study, we sought to prospectively evaluate short‐term LAAEFV changes after radiofrequency (RF) or cryoballoon ablation in paroxysmal AF.

Methods

This was a prospective substudy of the Effect of Cryoballoon and RF Ablation on Left Atrial Function (CryoLAEF) study ( ClinicalTrials.gov Identifier: NCT02611869). Thirty patients, randomly assigned to RF or cryoablation, were prospectively followed. Transesophageal echocardiograms were performed at baseline and at 3 months postablation to measure LAAEFV.

Results

All measurements were performed in sinus rhythm. Overall, LAAEFV was 44.2 [38.5–62.8] cm/s at baseline and was increased to 70.8 [64.8–77.6] cm/s at 3 months’ postablation (P < 0.001). Baseline LAAEFV was 52.5 [37.7–68.0] cm/s in the RF group and 42.8 [38.7–52.9] cm/s in the CryoBalloon group (P  =  0.653). At 3 months, the corresponding values were 68.5 [61.9–76.6] cm/s and 73.9 [69.2–79.9] cm/s, respectively (P  =  0.081 for the difference between the two groups at 3 months). The median change in LAAEFV was 11.0 [4.7–26.2] cm/s in the RF group versus 29.6 [15.8–37.0] cm/s in the CryoBalloon group (P  =  0.033).

Conclusion

LAA function is improved after catheter ablation with RF or balloon cryoablation in patients with paroxysmal AF, evaluated while in sinus rhythm both at baseline and on follow‐up.