Transesophageal echocardiographic assessment of left atrial and left atrial appendage function after radiofrequency ablation of atrial fibrillation

Background. The purpose of the present study was to assess late left atrial (LA) and left atrial appendage (LAA) function following radiofrequency ablation procedure that aimed to restore and maintain sinus rhythm (SR) in atrial fibrillation (AF). Methods. Twenty-six patients who underwent radiofrequency ablation procedure at least 6 months previously (median 1.24 years, range 0.6-2.6 years) were studied by transesophageal echocardiography. Patients were divided in two groups, group I with restored sinus rhythm and group II with AF recurrence. Twelve age and sex matched healthy subjects were selected as controls. The following parameters were obtained: LA diameter, LA ejection fraction (LAEF), LA wall late diastolic tissue velocity (A’, m/s), LAA diameter, LAA ejection fraction (LAAEF), LAA emptying (LAAEV) and filling (LAAFV) velocities (m/s), LAA systolic tissue velocity (SaV, m/s). Results. LA and LAA diameters were significantly larger in both groups compared to controls (p<.001 and <.005, respectively) despite a trend of higher decrease in patients in whom SR was restored. LAAEV and LAAEF were significantly lower in group II than in group I (21.9 +/- 13.7 cm/s vs 38.2 +/- 12.9 cm/s and 25.7 +/- 14.6% vs 42.4 +/- 11.7%, p<.005 for both comparisons). A’ and SaV were significantly lower in group II than in group I (3.8 +/- 1.1 cm/s vs 8.6 +/- 1.3 cm/s, p<.001, and 2.9 +/- 1.4 cm/s vs 9.5 +/- 1.2 cm/s, p<.0001). Decreased LAEF and LAAFV were determined in group I but no significant difference existed between group I and II. Conclusion. Although atrial function may remain modestly impaired after radiofrequency procedure because of ablation lesions or pre-existing atrial disease, SR restoration results in reverse atrial remodelling and improved atrial function. AF recurrence after ablation can be predicted by Doppler assessment of LA and LAA function.