Evaluation Of Left Atrial Size And Function In Patients With Atrial Fibrillation After Catheter Ablation By Real-Time Three-Dimensional Echocardiography And Speckle Tracking Imaging

Objective To evaluate left atrial (LA) size and function in atrial fibrillation (AF) patients after Radiofrequency catheter ablation (RFCA) by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI).Methods Thirty-five patients with AF underwent RFCA were studied, the AFs were divided into two groups, group AFi during sinus rhythm and group AF2 during AF. Echocardiography was performed before, 3 days and 1 month after RFCA in AF patients. The LA maximal, minimal volume index (LAVImax, LAVImin, LAVIp), LA total ejection fraction (LATEF), LA expansion index (LAEI), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) were measured by RT-3DE. The mean peak longitudinal LA strain (mSs, mSe, mSa), strain rate (mSRs, mSRe, mSRa) and LA stiffness (LASt) were acquired by 2D-STI. twenty-four healthy subjects as control group.Results ① Compared with the control group, AFs showed increased LAD, LAVImax, LAVImin and decreased LATEF, LAEI (all P< 0.01), LAVIp increased (P<0.01) and LAAEF decreased (P<0.05) in AF1 group.AF patients have decreased mSs, mSe, mSRs (all P<0.01). Sa, SRa was decreased in AF1 group(P< 0.01). Patients in AF2 group have disappeared Sa, SRa and increased LASt(P< 0.05). LASt showed a positive correlation with LAVImax, LAVImin, mSRe and LASt was negatively correlated with LATEF, LAEI, mSs, mSRs, mSe (all P<0.05). ② Comparing with pre-operative, AF1 group showed increased LAD, LAVImax, LAVImin (all P<0.01) and decreased LATEF, LAEI, LAPEF (all P<0.05).3 days after RFCA. mSs, mSe, mSa, mSRs, mSRe, mSRa decreased (all P<0.05) and LASt increased (P<0.01) 3 days after ablation in AF1 group. After 1 month, LA transversal diameter, LATEF, LAEI decreased and LASt increased (all P<0.05). Compared with 3 days after ablation, LAD, LAVImax, LAVImin, LASt decreased and LAPEF, mSs, mSe, mSa, mSRs, mSRe, mSRa improved 1 month after CPVA (all P< 0.05). ③ 3 days after ablation, AF2 group showed increased LA transversal diameter(P< 0.01) and LASt (P< 0.05) compared with pre-ablation. After 1 month, LAD, LAVImax, LAVImin decreased and LATEF, LAEI increased (all P<0.01). Compared with 3 days after ablation, LA anteroposterior diameter, LAVImax, LAVImin decreased and mSRe improved 1 month after RFCA (all P<0.01).Conclusions ① AFs have enlarged LA and decreased reservoir function, especially in patients during AF. AF patients during sinus rhythm have decreased booster pump function, the booster pump function disappear and LASt increased during AF. LA stiffness was significantly related with LAVImax, LAVImin, LA reservoir function and conduit function. ② The LASt increased 3 days after ablation in patients with AF. AF patients during sinu rhythm were in a deterioration 3 days after RFCA, LA enlarged and the reservoir, conduit, pump function of LA impaired. There was no significant difference in LA function between pre-ablation and 1 month after RFCA, patients during sinus rhythm have decreased LASt, LAV decreased in patients during AF. ③ Compared with 3 days after RFCA, Patients have decreased LA volume 1 month after ablation. AFs during sinu rhythm have increased LA reservoir, conduit, pump function and decreased LASt. The LA conduit function improved in patients during AF.