Study on Left Atrial Dimension and Function After Modified Endoscopic Procedure for Atrial Fibrillation at Two Years’ Follow-Up

• Published in: The Annals of thoracic surgery Vol. 101; no. 5; pp. 1724 - 1728
• Main Authors: Ma, Nan, MD, PhD, Zhao, Dongfang, BA, Zhao, Naishi, MD, Jiang, Zhaolei, MD, Ding, Fangbao, MD, PhD, Mei, Ju, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-05-2016
• Subjects: Aged; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - pathology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial Function, Left; Cardiothoracic Surgery; Echocardiography; Endoscopy; Female; Follow-Up Studies; Heart Atria - pathology; Humans; Male; Middle Aged; Surgery; LAAEF; AF; left atrial emptying fraction; minimum left atrial volume; LVEF; left atrial diameter; left atrial volume immediately before atrial systole; LAVP; LAA; LAD; LAVmax; left ventricular ejection fraction; maximum left atrial volume; atrial fibrillation; LAEF; left atrial active emptying fraction; sinus rhythm; left atrial appendage; LAVmin; SR
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.10.037

Background Modified endoscopic procedures for atrial fibrillation (AF) have a greater success rate because of the increased number of linear lesions. Concerns have been raised about the impact of ablation scars on the left atrium. This study aimed to examine the impact of ablation on left atrial dimension and systolic function after modified endoscopic procedures with echocardiographic measurement. Methods Of 107 patients undergoing modified endoscopic ablation, 58 had paroxysmal AF and 49 had persistent or long-standing AF. The procedure was performed on the beating heart through three ports on the left chest wall. Three circular and two linear lesions were made on the left atrium. The left atrial appendage was excised by stapler. Echocardiography was performed preoperatively and at the 2-year follow-up. Results Most patients (86.9%) patients were in sinus rhythm (SR) postoperatively. Fourteen patients (5 with paroxysmal AF and 9 with persistent/long-standing AF) failed to maintain SR. Echocardiographic data indicated that the left atrial diameter decreased only in the patients with postoperative SR but continued to increase in patients with fail SR maintenance. Left atrial function was also improved after the procedure, especially in patients with preoperative nonparoxysmal AF or with postoperative SR maintenance. Furthermore, left atrial function in patients who failed to restore SR was not worsened even with left atrial appendage excision. Conclusions Modified endoscopic procedure for AF improved post-procedural left atrial function of patients with SR maintenance. The left atrial function of patients with failed SR maintenance was also not worsened after left atrial appendage excision.