Changes of Left Atrial Function after Pulmonary Vein Isolation in Chronic Atrial Fibrillation

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Background: Effects of pulmonary vein isolation (PVI) on left atrial (LA) function in chronic atrial fibrillation (CAF) has not yet been clarified. Methods: Sixty patients who maintained sinus rhythm >1 year after PVI were enrolled. Echocardiographic examinations were repeated at baseline, 1 week, and 12 months after PVI. Maximum LA volume (LAV) at end-left ventricular (LV) systole, LAV at pre-atrial contraction, and minimum LAV at LV end-diastole were assessed. LA ejection fraction (LAEF) was calculated as changes in LAV by atrial contraction. LA strain analysis by speckle tracking echocardiography was used to assess LA function. LA strain-rate during LV systole were measured to assess LA reservoir function as well as the difference between the maximum and minimum LA volume (ΔLA max-min). LA longitudinal strain-rate at atrial contraction was measured to assess LA booster pump function as well as LAEF. Results: Each LA volume decreased over time. As for LA reservoir function, ΔLA max-min did not significantly change, however, peak LA longitudinal strain-rate at LV systole was increased at 12 months after PVI. As for LA booster pump function, although LAEF did not changed over time, peak LA longitudinal strain-rate at atrial contraction was increased 12 months after PVI. Conclusions: In patients with CAF, PVI produces LA reverse remodeling and improves LA reservoir and booster pump function.