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

Hsuan Ming Tsao, Mei Han Wu, Bien Hsien Huang, Shih Huang Lee, Kun Tai Lee, Ching Tai Tai, Yung Kuo Lin, Ming Hsiung Hsieh, Jen Yuan Kuo, Meng Huan Lei, Shih Ann Chen

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Abstract

Remodeling of PV and LA after AF Ablation. Introduction: Understanding the structural remodeling and reverse remodeling of the left atrium (LA) and pulmonary vein (PV) after radiofrequency ablation of atrial fibrillation (AF) may provide important insights into the mechanism and management of AF. This study used magnetic resonance angiographic (MRA) images to investigate changes in PV and LA morphologies before and more than 1 year after ablation. Method and Results: Forty-five patients (36 men and 9 women, mean age 60 ± 13 years) who underwent MRA before and more than 12 months (mean 21 ± 11) after ablation of paroxysmal AF were included in the study. The patients were divided into two groups: group I included 35 patients without AF recurrence, and group II included 10 patients with late (>1 month postablation) recurrence of AF. The sizes of the LA and nonablated PV were compared before and after ablation. In group I, significant reduction of ostial area of both superior PVs was noted (left superior PV: from 2.85 ± 0.67 to 2.59 ± 0.73 cm2; right superior PV: from 2.89 ± 0.85 to 2.60 ± 0.73 cm2, both P <0.001). Geometric alteration toward a round shape was noted in the ostia of superior PVs during follow-up (eccentricity of right superior PV and left superior PV decreased from 0.31 ± 0.10 to 0.22 ± 0.13 and from 0.27 ± 0.11 to 0.19 ± 0.13, respectively, oth P <0.01). However, LA volume showed only borderline reduction (from 61.52 ± 19.06 to 56.64 ± 17.13 mL, P = 0.05). In group II, significant dilation of the LA (from 61.14 ± 17.54 to 78.73 ± 25.27 mL, P = 0.004) and right superior PV (from 3.41 ± 1.12 to 4.08 ± 1.31 cm2, P = 0.016) was noted during follow-up. Ostial area and eccentricity of the left superior, left inferior, and right inferior PVs and LA were similar before and after ablation. Conclusion: Structural remodeling of the superior PVs and LA can be reversible after successful ablation without AF recurrence; however, late recurrence of AF is associated with progressive LA dilation.

Original languageEnglish
Pages (from-to)7-12
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume16
Issue number1
DOIs
Publication statusPublished - Jan 2005
Externally publishedYes

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Catheter Ablation
Pulmonary Veins
Heart Atria
Atrial Fibrillation
Magnetic Resonance Imaging
Recurrence
Dilatation
Magnetic Resonance Spectroscopy

Keywords

  • Atrial fibrillation
  • Pulmonary vein
  • Recurrence
  • Remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

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. / Tsao, Hsuan Ming; Wu, Mei Han; Huang, Bien Hsien; Lee, Shih Huang; Lee, Kun Tai; Tai, Ching Tai; Lin, Yung Kuo; Hsieh, Ming Hsiung; Kuo, Jen Yuan; Lei, Meng Huan; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 16, No. 1, 01.2005, p. 7-12.

Research output: Contribution to journalArticle

Tsao, Hsuan Ming ; Wu, Mei Han ; Huang, Bien Hsien ; Lee, Shih Huang ; Lee, Kun Tai ; Tai, Ching Tai ; Lin, Yung Kuo ; Hsieh, Ming Hsiung ; Kuo, Jen Yuan ; Lei, Meng Huan ; Chen, Shih Ann. / 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. In: Journal of Cardiovascular Electrophysiology. 2005 ; Vol. 16, No. 1. pp. 7-12.
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title = "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",
abstract = "Remodeling of PV and LA after AF Ablation. Introduction: Understanding the structural remodeling and reverse remodeling of the left atrium (LA) and pulmonary vein (PV) after radiofrequency ablation of atrial fibrillation (AF) may provide important insights into the mechanism and management of AF. This study used magnetic resonance angiographic (MRA) images to investigate changes in PV and LA morphologies before and more than 1 year after ablation. Method and Results: Forty-five patients (36 men and 9 women, mean age 60 ± 13 years) who underwent MRA before and more than 12 months (mean 21 ± 11) after ablation of paroxysmal AF were included in the study. The patients were divided into two groups: group I included 35 patients without AF recurrence, and group II included 10 patients with late (>1 month postablation) recurrence of AF. The sizes of the LA and nonablated PV were compared before and after ablation. In group I, significant reduction of ostial area of both superior PVs was noted (left superior PV: from 2.85 ± 0.67 to 2.59 ± 0.73 cm2; right superior PV: from 2.89 ± 0.85 to 2.60 ± 0.73 cm2, both P <0.001). Geometric alteration toward a round shape was noted in the ostia of superior PVs during follow-up (eccentricity of right superior PV and left superior PV decreased from 0.31 ± 0.10 to 0.22 ± 0.13 and from 0.27 ± 0.11 to 0.19 ± 0.13, respectively, oth P <0.01). However, LA volume showed only borderline reduction (from 61.52 ± 19.06 to 56.64 ± 17.13 mL, P = 0.05). In group II, significant dilation of the LA (from 61.14 ± 17.54 to 78.73 ± 25.27 mL, P = 0.004) and right superior PV (from 3.41 ± 1.12 to 4.08 ± 1.31 cm2, P = 0.016) was noted during follow-up. Ostial area and eccentricity of the left superior, left inferior, and right inferior PVs and LA were similar before and after ablation. Conclusion: Structural remodeling of the superior PVs and LA can be reversible after successful ablation without AF recurrence; however, late recurrence of AF is associated with progressive LA dilation.",
keywords = "Atrial fibrillation, Pulmonary vein, Recurrence, Remodeling",
author = "Tsao, {Hsuan Ming} and Wu, {Mei Han} and Huang, {Bien Hsien} and Lee, {Shih Huang} and Lee, {Kun Tai} and Tai, {Ching Tai} and Lin, {Yung Kuo} and Hsieh, {Ming Hsiung} and Kuo, {Jen Yuan} and Lei, {Meng Huan} and Chen, {Shih Ann}",
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T1 - Morphologic remodeling of pulmonary veins and left atrium after catheter ablation of atrial fibrillation

T2 - Insight from long-term follow-up of three-dimensional magnetic resonance imaging

AU - Tsao, Hsuan Ming

AU - Wu, Mei Han

AU - Huang, Bien Hsien

AU - Lee, Shih Huang

AU - Lee, Kun Tai

AU - Tai, Ching Tai

AU - Lin, Yung Kuo

AU - Hsieh, Ming Hsiung

AU - Kuo, Jen Yuan

AU - Lei, Meng Huan

AU - Chen, Shih Ann

PY - 2005/1

Y1 - 2005/1

N2 - Remodeling of PV and LA after AF Ablation. Introduction: Understanding the structural remodeling and reverse remodeling of the left atrium (LA) and pulmonary vein (PV) after radiofrequency ablation of atrial fibrillation (AF) may provide important insights into the mechanism and management of AF. This study used magnetic resonance angiographic (MRA) images to investigate changes in PV and LA morphologies before and more than 1 year after ablation. Method and Results: Forty-five patients (36 men and 9 women, mean age 60 ± 13 years) who underwent MRA before and more than 12 months (mean 21 ± 11) after ablation of paroxysmal AF were included in the study. The patients were divided into two groups: group I included 35 patients without AF recurrence, and group II included 10 patients with late (>1 month postablation) recurrence of AF. The sizes of the LA and nonablated PV were compared before and after ablation. In group I, significant reduction of ostial area of both superior PVs was noted (left superior PV: from 2.85 ± 0.67 to 2.59 ± 0.73 cm2; right superior PV: from 2.89 ± 0.85 to 2.60 ± 0.73 cm2, both P <0.001). Geometric alteration toward a round shape was noted in the ostia of superior PVs during follow-up (eccentricity of right superior PV and left superior PV decreased from 0.31 ± 0.10 to 0.22 ± 0.13 and from 0.27 ± 0.11 to 0.19 ± 0.13, respectively, oth P <0.01). However, LA volume showed only borderline reduction (from 61.52 ± 19.06 to 56.64 ± 17.13 mL, P = 0.05). In group II, significant dilation of the LA (from 61.14 ± 17.54 to 78.73 ± 25.27 mL, P = 0.004) and right superior PV (from 3.41 ± 1.12 to 4.08 ± 1.31 cm2, P = 0.016) was noted during follow-up. Ostial area and eccentricity of the left superior, left inferior, and right inferior PVs and LA were similar before and after ablation. Conclusion: Structural remodeling of the superior PVs and LA can be reversible after successful ablation without AF recurrence; however, late recurrence of AF is associated with progressive LA dilation.

AB - Remodeling of PV and LA after AF Ablation. Introduction: Understanding the structural remodeling and reverse remodeling of the left atrium (LA) and pulmonary vein (PV) after radiofrequency ablation of atrial fibrillation (AF) may provide important insights into the mechanism and management of AF. This study used magnetic resonance angiographic (MRA) images to investigate changes in PV and LA morphologies before and more than 1 year after ablation. Method and Results: Forty-five patients (36 men and 9 women, mean age 60 ± 13 years) who underwent MRA before and more than 12 months (mean 21 ± 11) after ablation of paroxysmal AF were included in the study. The patients were divided into two groups: group I included 35 patients without AF recurrence, and group II included 10 patients with late (>1 month postablation) recurrence of AF. The sizes of the LA and nonablated PV were compared before and after ablation. In group I, significant reduction of ostial area of both superior PVs was noted (left superior PV: from 2.85 ± 0.67 to 2.59 ± 0.73 cm2; right superior PV: from 2.89 ± 0.85 to 2.60 ± 0.73 cm2, both P <0.001). Geometric alteration toward a round shape was noted in the ostia of superior PVs during follow-up (eccentricity of right superior PV and left superior PV decreased from 0.31 ± 0.10 to 0.22 ± 0.13 and from 0.27 ± 0.11 to 0.19 ± 0.13, respectively, oth P <0.01). However, LA volume showed only borderline reduction (from 61.52 ± 19.06 to 56.64 ± 17.13 mL, P = 0.05). In group II, significant dilation of the LA (from 61.14 ± 17.54 to 78.73 ± 25.27 mL, P = 0.004) and right superior PV (from 3.41 ± 1.12 to 4.08 ± 1.31 cm2, P = 0.016) was noted during follow-up. Ostial area and eccentricity of the left superior, left inferior, and right inferior PVs and LA were similar before and after ablation. Conclusion: Structural remodeling of the superior PVs and LA can be reversible after successful ablation without AF recurrence; however, late recurrence of AF is associated with progressive LA dilation.

KW - Atrial fibrillation

KW - Pulmonary vein

KW - Recurrence

KW - Remodeling

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