Positive left atrial remodeling in patients with paroxysmal atrial fibrillation after a successful radiofrequency pulmonary vein isolation

Background: A potential relationship between the initial left atrial (LA) echocardiographic parameters and LA remodeling after pulmonary vein isolation using (PVI) radiofrequency energy energy with effectiveness of this treatment was discussed. Aim: We aimed to determine the relationship between initial and post-follow-up transthoracic echocardiography-derived predictors of successful PVI in patients with paroxysmal atrial fibrillation (AF). Methods: Eighty patients with paroxysmal AF (aged 58 [interquartile range, IQR, 50-63] years; male, 50 [62.5%]), hospitalized for the first PVI procedure were included. Before and after a minimum of 6 months of follow-up, clinical and echocardiographic evaluations were performed. LA morphological parameters (diameter, volumes, and other detailed LA parameters), as well as LA peak segmental and global longitudinal strains (PLS) and LA wall strain synchrony were assessed. Results: In the whole group after the follow-up period, patients presented higher mean LA Volconduit. Patients with no AF recurrences had lower post-PVI LA volumes, higher LA ejection fraction, and LA expansion index when compared to the patients after ineffective PVI. Patients who maintained sinus rhythm after the PVI procedure were characterized by higher initial segmental strains: LA PLSbasal-inferior and PLSapical-septal, as well as higher LA wall strain dispersion over time. Conclusions: Some echocardiographic parameters related to LA morphology improve after successful PVI treatment. LA strains and wall strain dispersion over time are not related to LA remodeling after a successful PVI procedure. However, the baseline LA standard and novel echocardiographic parameters cannot be used for remote evaluation of the effectiveness of the PVI procedure.