Left atrial structural remodelling and restoration of atrial contraction after successful thoracoscopic epicardial microwave pulmonary vein isolation.
Authors:
Z. Peroutka 1; Z. Straka 2; P. Osmančík 1; M. Pěnička 1; H. Línková 1; M. Herold 1
Authors‘ workplace:
III. Interní - Kardiologická klinika
Přednosta: prof. MUDr. Petr Widimský, DrSc.
1; Kardiochirurgická klinika
Přednosta: prof. MUDr. Zbyněk Straka, CSc.
Kardiocentrum Fakultní nemocnice Královské Vinohrady a 3. lékařské fakulty Univerzity Karlovy, Praha
2
Published in:
Prakt. Lék. 2008; 88(2): 94-100
Category:
Of different specialties
Overview
Aim:
Atrial fibrillation (AF) is accompanied by the lack of contractile function and successive progression of atrial volumes. Endoscopic microwave pulmonary isolation represents a new technique of AF ablation (the isolation of pulmonary veins by epicardial approach). The aim of the study was to assess the function and size of left atrium (LA) after successful procedure.
Methods:
11 patients with symptomatic paroxysmal or persistent AF were prospectively studied. All of them underwent an ablation procedure. The efficacy of the procedure was assessed by 48 h. Holter recordings 1 and 3 months after the procedure, only 9 patients with full restoration and maintenance of sinus rhythm were analyzed. Echocardiography was performed before (baseline), then 1 and 3 months following the procedure. Parameters studied were:
left LA diameter (DS),
maximal volume of LA during ventricular systole (ESV),
minimal volume of LA during ventricular diastole (EDV), and
ejection fraction of LA (LAEF).
Peak velocity of atrial contraction (A velocity), velocity time integral of the A wave (AVTI) and peak velocity of mitral annular motion in late diastole (Aa) were measured by Doppler or tissue Doppler respectively.
Results:
Compared with baseline values, EDV volume decreased significantly 3 months after the procedure (EDV 53,9±14,9 ml vs. 47,4±16,2 ml, p<0.05). Furthermore, transient decrease of LA mechanical function (LAEF, Aa, A velocity) was observed one month after procedure with the recovery at 3 m. (LA EF 35,3±5,2 % vs. 32,4±7,8 %, Aa 6,52±0,83 cm/s vs. 6,55±1,16 cm/s, Avel: 0,55±0,04 m/s vs. 0,55±0,1 m/s, all p=n.s.).
Conclusion:
The successful restoration and maintenance of sinus rhythm by EndoMaze procedure is associated with progressive decrease of EDV. However, the contractile function of LA is transiently decreased shortly after procedure.
Key words:
atrial fibrillation, ablation, pulmonary vein isolation, left atrium, mechanical function of left atrium.
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