Evaluating The Change Of Left Atrial And Left Atrial Appendage Function In The Patients With Atrial Fibrillation Underwent Catheter Ablation By Two-dimensional Echocardiography And Real-time Three-dimensional Echocardiography

Objective:To evaluate the change of left atrial and left atrial appendage function in patients with atrial fibrillation after catheter ablation using two-dimensional echocardiography and real-time three-dimensional echocardiography.Methods : Transthoracic echocardiography and transesochageal echocardiography were performed for 45 atrial fibrillation patients who underwent catheter ablation pre-operation,3 days,3 months after operation.Transthoracic echocardiography parameters:(1)Left atrial diameter(LADa,LADb,LADc)in the conventional left ventricular long axis and apical four-chamber measured;(2)Left ventricular outflow tract velocity-time integral(LVOT-VTI)by pulsed Doppler in the apical five-chamber heart measurement;(3)Left atrial volume index(LAVImax)was calculated by dividing maximal left atrial volume by the body surface area(BSA;worked out with the Dubois formula,using body height and weight);(4)The left atrial maximal,minimal and pre-systolic volume(LAVmax,LAVmin and LAVp)were measured by real time three-dimensional echocardiograph(RT-3DE)respectively.Left atrial passive ejection fraction(LAPEF),left atrial active ejection fraction(LAAEF),left atrial ejection fraction(LAEF)and LAFI were calculated;(5)Early and late diastolic transmitral flow velocity(E,A)were obtained in the mitral valve;Transesophageal echocardiography parameters:(6)Two-dimensional Simpson method at 135 ° to calculate the change of the maximum volume and minimum volume to calculate left atrial appendage function(LAAS-EF);(7)Real-time Three-dimensional echocardiography stored LAA dynamicimages,LAAV-EF was calculated by calculating the volume change of left atrial appendage volume by 3DQ mode;(8)Left atrial appendage peak emptying velocity(LAA-PEV)was also measured.Results : In paroxysmal atrial fibrillation group :Compared with preoperative,LA anteroposterior diameter(LADa?LADb ?LADc)were decreased after 3 months(P<0.05);LAVmax?LAVmin and LAVImax were decreased after 3 months(P <0.05);LAFI ? A were decreased after 3 days(P<0.05)and increased after 3 months(P<0.05);Compared to 3 days after operative,LAEF?LAAEF were increased after 3months operation(P <0.05);LAPEF? E were not statistically significant before and after operative(P>0.05).In persistent atrial fibrillation group :Comparing with preoperative,3 days post-ablation LADa ? LADb ? LADc had a enlargement trend(P>0.05),but LADa ?LADc were decreased after 3 months(P <0.05);LAVmax?LAVmin and LAVImax were increased after 3 days(P>0.05).but they were decreased after 3 months(P <0.05);LAEF ?LAFI were decreased after 3 days and increased after3 months(P<0.05);LAAEF ?LAPEF?A were improved after 3 months(P <0.05);E was increased 3 months after operation(P <0.05);The LAA-EDV ? LAA-ESV ?LAA-EDS ? LAA-ESS were decreased after 3 months in both groups(P<0.05);LAAV-EF ? LAAS-EF ? LAA-PEV were increased in persistent atrial fibrillation group(P <0.05),but they were not statistically significant before and after operative in paroxysmal atrial fibrillation group;Before the operative LAAV-EF and LAAS-EF had a positively correlation(r = 0.49,P = 0.001),LAA-PEV and LAAV-EF had a positively correlation(r = 0.61,P = 0.000),LAA-PEV was positively correlated with LAFI(r =0.46,P = 0.002).;LAAV-EF and LAAS-EF had a positively correlation(r = 0.54,P =0.000)LAA-PEV and LAAV-EF had a positively correlation(r = 0.67,P =0.000),LAA-PEV was positively correlated with LAFI(r = 0.55,P = 0.000).after the operative.Conclusions : Left atrial function was in a deterioration three days after catheter ablation but Left atrial function and left atrial appendage function were improved obviously in 3 months after catheter ablation.Catheter ablation is an effectivetreatment for patients with AF;3RT-DE technology can be used to measure the volume of the left atrium and left atrial appendage,left atrium and left atrial appendage function changes can be evaluated efficiently;In atrial fibrillation group,the left atrial function index has a certain predictive value for the left atrial appendage function,patients with TEE contraindications can indirectly assess left atrial appendage function by measuring left atrial function index with TTE;The combination of 2DE ? PW and 3RT-DE technologies can provide more comprehensive information for the clinic.