https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Kreislauferkrankungen Tübingen, Deutschland; 2Kinderheilkunde II Kinderkardiologie, Intensivmedizin und Pulmologie Tübingen, Deutschland; 3Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Angiologie Tübingen, Deutschland
Rhythm control with catheter ablation in atrial fibrillation (AF) is emerging as the first line therapy in a wider field of patients. Pulmonary vein isolation (PVI) with restoration of sinus rhythm and preservation of atrial function and remodeling of atrial cardiomyopathy could be one of the corner stones. Therefore, breaking the vicious circle of enlarging atria, progressive atrial fibrosis and consequently transition of paroxysmal into persistent atrial fibrillation is of special interest to be monitored after therapy.
Aims:
We aimed to evaluate left (LA) and right atrial (RA) function and dimension parameters with state of the art 3D-echocardiography, analyzing left and right atrial emptying fraction (LAEF, RAEF, respectively), left and right atrial reservoir (LAresv, RAresv) and contraction strain (LAcont, RAcont), with special interest on paroxysmal and persistent AF in the time course after PVI and a longer period of restored sinus rhythm.
Methods and Results:
Patients presenting for PVI were consecutively analyzed when they presented in sinus rhythm, paroxysmal (n=34) and persistent (n=12) AF. 3D-echocardiography was performed before and at 3 months of follow-up (FU). Median CHA2DS2-VAc score was 2, all patients presented in sinus rhythm. Bi-atrial area and volume decreased significantly, in paroxysmal AF even more (area p<0.001) compared to persistent AF (area p<0.05). Interestingly, LAEF only improved in persistent AF (p<0.05), whereas RAEF increased in both of AF types, even though the mean delta was smaller compared to LAEF. Concomitantly, atrial filling resembled by left and right atrial reservoir strain (paroxysmal p<0.001, persistent p<0.05) and contraction.
Conclusion:
Irrespective of paroxysmal or persistent atrial fibrillation, atrial remodeling is observed after PVI. Interestingly, LAEF was only improved significantly in persistent AF in our cohort, most likely suggesting a higher deterioration of LA contractility due to higher burden of AF and negative remodeling processes. Finally, sinus rhythm restores bi-atrial function and reduces bi-atrial voluminal, leading to positive remodeling.