Abstract
Introduction
The effect of different treatment strategies of atrial fibrillation on left atrial (LA) size has not been compared in lone paroxysmal atrial fibrillation. The objective of the present study was to evaluate the evolution of LA size over time in patients who underwent different treatment interventions.
Methods and results
Two hundred forty patients with lone paroxysmal atrial fibrillation were assigned to four groups. The circumferential pulmonary vein ablation (CPVA) group (n = 60) was treated with CPVA, segmental pulmonary vein isolation (SPVI) group (n = 60) with SPVI, AMIO group (n = 60) with amiodarone alone, and AMIO + LO group (n = 60) with amiodarone plus losartan. LA diameter was measured with transthoracic echocardiogram at baseline, 3, 6, 9, and 12 months after the interventions. In the CPVA group, LA size at third, sixth, ninth, and 12th month had a significant decrease than that at baseline and in the other three groups. LA size in patients with atrial fibrillation recurrence in the four groups was significant higher than that in patients with no atrial fibrillation recurrence (P = 0.002–0.001).
Conclusion
The results suggested that a shortened LA size is not consistent with improved sinus rhythm maintenance. Although maintenance of sinus rhythm is not the only factor in determining shrinking or enlargement of the left atrium, inhibiting or eliminating activity of the pulmonary vein is very important for paroxysmal atrial fibrillation. Atrial fibrillation recurrence is a main factor contributing to enlargement of the LA.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Prystowsky, E. N., Benson, D. W., & Fuster, V. (1996). Management of patients with atrial fibrillation: A statement of health care professionals from the subcommittee of electrocardiography and electrophysiology, American Heart Association. Circulation, 93, 1262–1277.
Henry, W. L., Morganroth, J., Pearlman, A. S., Clark, C. E., Redwood, D. R., Itscoitz, S. B., et al. (1976). Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation, 53, 273–279.
Kamata, J., Kawazoe, K., Izumoto, H., Kitahara, H., Shiina, Y., Sato, Y., et al. (1997). Predictors of sinus rhythm restoration after Cox Maze procedure concomitant with other cardiac operations. The Annals of Thoracic Surgery, 64, 394–398.
Karch, M. R., Zrenner, B., Deisenhofer, I., Schreieck, J., Ndrepepa, G., Dong, J., et al. (2005). Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation. Circulation, 111, 2875–2880.
Haissaguerre, M., Shah, D. C., Jais, P., Hocini, M., Yamane, T., Deisenhofer, I., et al. (2000). Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation, 102, 2463–2465.
Beukema, W., Elvan, A., Sie, H., Ramdat Misier, A., & Wellens, H. (2005). Successful radiofrequency ablation in patients with previous atrial fibrillation results in a significant decrease in left atrial size. Circulation, 112, 2089–2095.
Lemola, K., Sneider, M., Desjardins, B., Case, I., Chugh, A., Hall, B., et al. (2004). Effects of left atrial ablation of atrial fibrillation on size of the left atrium and pulmonary veins. Heart Rhythm, 1, 576–581.
Tsao, H., Wu, M., Huang, B., Lee, S., Lee, K., Tai, C., et al. (2005). Morphologic remodeling of pulmonary veins and left atrium after catheter ablation of atrial fibrillation: Insight from long-term follow-up of three-dimensional magnetic resonance imaging. Journal of Cardiovascular Electrophysiology, 16, 7–12.
Haissaguerre, M., Jais, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339, 659–666.
Chen, S. A., Hsieh, M. H., & Tai, C. T. (1999). Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiologic characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation, 100, 1879–1886.
Madrid, A. H., Bueno, M. G., Rebollo, J. M., Marin, I., Pena, G., Bernal, E., et al. (2002). Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: A prospective and randomized study. Circulation, 106, 331–336.
Yin, Y., Dalal, D., Liu, Z., Wu, J., Liu, D., Lan, X., et al. (2006). Prospective randomized study comparing amiodarone vs. amiodarone plus losartan vs. amiodarone plus perindopril for the prevention of atrial fibrillation recurrence in patients with lone paroxysmal atrial fibrillation. European Heart Journal, 27, 1841–1846.
Chen, Y. J., Chen, Y. C., Tai, C. T., Yeh, H. I., Lin, C. I., & Chen, S. A. (2006). Angiotensin II and angiotensin II receptor blocker modulate the arrhythmogenic activity of pulmonary veins. British Journal of Pharmacology, 147(1), 12–22.
Wijffels, M. C., Kirchhof, C. J., Dorland, R., & Allessie, M. A. (1995). Atrial fibrillation begets atrial fibrillation-A study in awake chronically instrumented goats. Circulation, 92, 1954–1968.
Nakashima, H., Kumagai, K., Urata, H., Gondo, N., Ideishi, M., & Arakawa, K. (2000). Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation, 101, 2612–2617.
Sanfilippo, A. J., Abascal, V. M., Sheehan, M., Oertel, L. B., Harrigan, P., Hughes, R. A., et al. (1990). Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation, 82, 792–797.
Frustaci, A., Chimenti, C., Bellocci, F., Morgante, E., Russo, M. A., & Maseri, A. (1997). Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation, 96, 1180–1184.
Kumagai, K., Nakashima, H., Urata, H., Gondo, N., Arakawa, K., & Saku, K. (2003). Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation. Journal of the American College of Cardiology, 41, 2197–2204.
Brasch, H., Sieroslawski, L., & Dominiak, P. (1993). Angiotensin II increases norepinephrine release from atria by acting on angiotensin subtype 1 receptors. Hypertension, 22, 699–704.
Moreau, N., Richer, C., Vincent, M. P., & Giudicelli, J. F. (1993). Sympathoinhibitory effects of losartan in spontaneously hypertensive rats. Journal of Cardiovascular Pharmacology, 22, 126–134.
Buikema, H., van Veldhuisen, D. J., Hegeman, H., & van Gilst, W. H. (1997). Early pharmacologic intervention may prevent the deterioration in endothelial function after experimental myocardial infarction in rats: Effects of ibopamine and captopril. Journal of Cardiac Failure, 3, 125–132.
Jayam, V. K., Dong, J., Vasamreddy, C. R., Lickfett, L., Kato, R., Dickfeld, T., et al. (2005). Atrial volume reduction following catheter ablation of atrial fibrillation and relation to reduction in pulmonary vein size: An evaluation using magnetic resonance angiography. Journal of Interventional Cardiac Electrophysiology, 13, 107–114.
Author information
Authors and Affiliations
Corresponding author
Additional information
Drs. Zengzhang Liu and Zhiyu Ling are co-first authors for this paper.
Rights and permissions
About this article
Cite this article
Liu, Z., Ling, Z., Su, L. et al. The effect of different treatment strategies on left atrial size in patients with lone paroxysmal atrial fibrillation—a prospective cohort study. J Interv Card Electrophysiol 23, 167–173 (2008). https://doi.org/10.1007/s10840-008-9301-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-008-9301-7