5.2 Hemodynamics of LAA
Our data can provide pathophysiologic insight to the potential reduction
of ischemic stroke after RFCA: a significant improvement of LAA flow
volume after RFCA. In our RFCA cohort including both paroxysmal and
non-paroxysmal AF patients, VENC-MRI was increased by 44% after RFCA.
Rhythm theory and atrial cardiomyopathy theory are two major
explanations for the increased risk of ischemic stroke in AF
patients.2,
18 Although there are no concrete
evidence that RFCA can reverse atrial cardiomyopathy, successful
maintenance through RFCA will significantly improve the hemodynamics of
LAA as demonstrated in this study. In our cohort, those without late
recurrence had significantly greater improvement in VENC-MRI (∆VENC-MRI
= 15.55 ± 41.41 vs. 25.75 ± 37.00; p = 0.016). Those with low VENC-MRI
before RFCA also had greater improvements (∆VENC-MRI = 16.72 ± 38.39 vs.
50.64 ± 28.92; p < 0.001). Our results suggest successful
maintenance of sinus rhythm thorough RFCA especially in those with
limited LAA function at baseline can have significant positive impact on
LAA hemodynamics. Whether this beneficial effect on LAA flow volume will
lead to decrease in clinical ischemic stroke needs further
investigation.