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.
Sources
1. Fuster, V., Rydén, L.E., Cannom, D.S. et al., American College of Cardiology; American Heart Association task force on practice guidelines; European Society of Cardiology Comittee for practice guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ /ESC. Guidelines for the managment of patients with atrial fibrillation. Europace 2006, 8(9), p. 651-745.
2. Calkins, H., Brugada, J., Packer, D.L. et al. European Heart Rhythm Association (EHRA); European Cardiac Arrhythmia Society (ECAS); American College of Cardiology (ACC); American Heart Association (AHA); Society of Thoracic Surgeons (STS); HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007, 4(6), p. 816-861.
3. La Meir, M., De Roy L., Blommaert, M.D., Buche M. Treatment of lone atrial fibrillation with a right thoracoscopic approach. Ann. Thorac. Surg. 2007, 83(6), p. 2244-2245.
4. Pruitt, J.C., Lazzara, R.R., Dworkin, G.H., et al. Totally endoscopic ablation of lone atrial fibrillation: initial clinical experience. Ann. Thorac. Surg. 2006, 81(4), p. 1325-1330.
5. Sagbas, E., Akpinar, B., Sanisoglu , I., et al. Video-assisted bilateral epicardial pulmonary vein isolation for the treatment of lone atrial fibrillation. Ann. Thorac. Surg. 2007, 83(5), p.1724-1730.
6. Wolf, R.K., Schneeberger, E.W., Osterday, R., et al. Video assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J. Thorac. Cardiovasc Surg. 2005, 130(3), p. 797-802.
7. Bisleri, G., Manzato, A., Argenziano, M., et al. Thoracoscopic epicardial pulmonary vein ablation for lone paroxysmal atrial fibrillation. Europace 2005, 7(2), p. 145-148.
8. Pappone, C., Rosanio, S., Augello, G., et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long–term study. J. Am. Coll. Cardiol. 2003, 42, p. 185-197.
9. Cox, J.L., Ad, N., Palazzo, T. Impact of the maze procedure on the stroke rate in patiens with atrial fibrillation. J. Thorac. Cardiovasc. Surg. 1999, 118(5), p. 833-840.
10. Bando, K., Kobayashi, J., Kosakai, Y., et al. Impact of Cox Maze procedure on outcome in patiens with atrial fibrillation and mitral valve disease. J. Thorac. Cardiovasc. Surg. 2002, 124(3), p. 575-583.
11. Handa, N., Schaff, H.V., Morris, J.J., et al. Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation . J. Thorac. Cardiovasc. Surg. 1999, 118(4), p. 628-635.
12. Fiala, M., Chovančík, J., Moravec, R. a kol. Recidivující arytmie po katetrové ablaci původně paroxysmální fibrilace síní a výsledky opakované ablace. Vnitř. lék. 2007, 53(12), s. 1248-1254.
13. Ujino, K., Barnes, M.E., Cha, S.S., et al. Two-dimensional echocardiographic methods for assessment of left atrial volume. Am .J. Cardiol. 2006, 98(9), p. 1185-1188.
14. Kircher, B., Abbott, J.A., Pau, S., et al. Left atrial volume determination by biplane-two dimensional echocardiography: validation by cine computed tomography. Am. Heart. J. 1991, 121(3, Pt 1), p. 864-871.
15. Thomas, L., Levett, K., Boyd, A., et al. Changes in regional left atrial function with aging: evaluation by Doppler tissue imaging. Eur. J. Echocardiogr. 2003, 4, p. 92-100.
16. Yuda, S., Nakatani, S., Kosakai, Y., et al. Long-term follow-up of atrial contraction after the maze procedure in patients with mitral valve disease. J. Am. Coll. Cardiol. 2001, 37(6), p. 1622-1627.
17. Jessurun, E.R., van Hemel, N.M., Kelder J.C., et al. The effect of maze operations on atrial volume. Ann. Thorac. Surg. 2003, 75(1), p. 51-56.
18. Thomas, L., Boyd, A., Thomas, S.P., et al. Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation. Eur. Heart. J. 2003, 24(21), p. 1942-1951.
19. Yuda, S., Nakatani, S., Isobe, F., et al. Comparative efficacy of the maze procedure for restoration of atrial contraction in patiens with and without giant left atrium associated with mitral valve disease. J. Am..Coll. Cardiol.1998, 31, p. 1097-1102.
20. Lee, J.W., Choo, J.S., Kim, K.I., et al. Atrial fibrillation surgery simplified with cryoablation to improve left atrial function. Ann. Thorac. Surg. 2001, 72(5), p. 1479-1483.
21. Yashima, N., Nasu, M., Kawazoe, K., Hiramori, K. Serial evaluation of atrial function by Doppler echocardiography after the maze procedure for chronic atrial fibrillation. Eur. Heart. J. 1997, 18(3), p. 496-502.
22. Feinberg, M.S., Waggoner, A.D., Kater, K.M., et al. Restoration of atrial function after the maze procedure for patiens with atrial fibrillation. Assessment by Doppler echocardiography. Circulation 1994, 90(5, Pt 2), p. 285-292.
23. Yamanaka, K., Fujita, M., Doi, K., et al. Multislice computed tomography accurately quantifies left atrial size and function after the MAZE procedure. Circulation 2006, 114 (1 Suppl), p. I5-9.
24. Lönnerholm, S., Blomström, P., Nilsson, L., Blomström-Lundqvist, C. Atrial size and transport function after the Maze III procedure for paroxysmal atrial fibrillation. Ann. Thorac. Surg. 2002, 73(1), p. 107-111.
25. Pappone, C., Oreto, G., Rosanio, S., et al. Atrial electroanatomic remodelling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001, 104(21), p. 2539-2544.
26. Reant, P., Lafitte, S., Jaïs, P., et al. Reverse remodelling of the left cardiac chambers after catheter ablation after 1 year in a series of patiens with isolated atrial fibrillation. Circulation 2005, 112 (19), 2896-2903.
27. Beukema, W.P., Elvan, A., Sie, H.T., et al. Successful radiofrequency ablation in patients with previous atrial fibrillation results in a significant decrease in left atrial size. Circulation 2005, 112(14 ), p. 2089-2095.
28. Tops, L.F., Bax, J.J., Zeppenfeld, K., et al. Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size. Am. J. Cardiol. 2006, 97(8), p. 1220-1222.
29. Oral, H., Pappone, C., Chugh, A., et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N. Engl. J. Med. 2006, 354(9), p. 934-941.
30. Takahashi, Y., O‘Neill, M.D., Hocini, M., et al. Effects of stepwise ablation of chronic atrial fibrillation on atrial electrical and mechanical properties. J. Am. Coll. Cardiol. 2007, 49(12), p. 1306-1314.
31. Lemola, K., Sneider, M., Desjardins, B., et al. Effects of left atrial ablation of atrial fibrillation on size of the left atrium and pulmonary veins. Heart Rhythm 2004, 1(5), p. 576-581.
32. Verma, A., Kilicaslan, F., Adams, J.R., et al. Extensive abation during pulmonary vein antrum isolation has no adverse impact on left atrial function: an echocardiography and cine computed tomography analysis. J. Cardiovasc. Electrophysiol. 2006, 17(7), p. 741-746.
33. Tsao, H.M., Wu, M.H., Juany B.H., et al. Morphologic remodeling of pulmonary veins and left atrium after catheter ablation of atrial fibrillation: insight from long-term follow-up of three-dimensional magnetic resonance imaging. J. Cardiovasc. Electrophysiol. 2005, 16(1), p. 7-12.
34. Lemola, K., Desjardins, B., Sneider, M., et al. Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function. Heart Rhythm 2005, 2(9), p. 923-928.
35. Accord, R.E., van Zuzlen R.J., van Brakel, T.J., Maessen, J.G. Post-mortem histologic evaluation of microwave lesions after epicardial pulmonary vein isolation for atrial fibrillation. Ann. Thorac. Surg. 2005, 80(3), p. 881-887.
36. Okada, T., Yamada, T., Murakami, Y., et al. Prevalence and severity of left atrial edema detected by electron beam tomography early after pulmonary vein ablation. J. Am. Coll. Cardiol. 2007, 49(13), p. 1436-1442.
Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2008 Issue 2
Most read in this issue
- Memory and its disturbances
- Current possibilities and problems of antiretroviral therapy
- The hoarding of possessions and animals
- Acute toxic hepatitis following consumption of a herbal preparation