Blood Flow Volume of Left Atrial Appendage Measured by Magnetic
Resonance Imaging is Improved after Radiofrequency Catheter Ablation of
Atrial Fibrillation
Abstract
Introduction: Hemodynamics of left atrial appendage (LAA) is an
important factor for future risk of ischemic stroke in atrial
fibrillation (AF) patients and velocity encoded cardiac magnetic
resonance imaging (VENC-MRI) can evaluate blood flow volume of LAA
without any invasive procedures. We aimed to evaluate the impact of
radiofrequency catheter ablation (RFCA) on LAA hemodynamics via MRI
evaluation. Methods and Results: Consecutive RFCA cases in a single
arrhythmia center were retrospectively analyzed. A total of 3,120 AF
patients who underwent first RFCA were analyzed. Among these patients
360 patients had both pre- and post-RFCA VENC-MRI evaluation. Atrial
fibrillation was non-paroxysmal in 174 (48.3%) patients. Mean VENC-MRI
(ml/sec) was significantly improved after RFCA with 49.75±32.97 and
71.92±34.94 for pre- and post-RFCA, respectively. Patients with
non-paroxysmal AF (∆VENC-MRI = 29.71±35.30 vs. 14.42±40.94; p
< 0.001) and low pre-RFCA VENC-MRI (∆VENC-MRI = 50.64±28.92
vs. 16.72±38.39; p < 0.001) had significantly higher
improvement in VENC-MRI. Those who experienced late recurrence before
post-RFCA MRI had significantly less improvement in LAA flow volume
(∆VENC-MRI = 15.55±41.41 vs. 25.75±37.00; p = 0.016). Similar results
were obtained after adjusting covariates. Conclusions: Radiofrequency
catheter ablation can significantly improve hemodynamics of LAA in AF
patients. The beneficial effects were most prominent in non-paroxysmal
AF, those who had low pre-RFCA VENC-MRI, and those without late
recurrence. Whether the improved hemodynamics of LAA after RFCA actually
leads to reduced risk of ischemic stroke should be evaluated in future
trials.