Left Atrial Structural and Functional Changes After Pulmonary Vein Isolation Using Different Energy Sources.

Background

Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF); however, its impact on long-term left atrial (LA) structural and mechanical remodeling may differ between ablation techniques.

Objectives

The aim of this study is to assess changes in LA structure and function after PVI using cryoballoon ablation (CBA) and radiofrequency catheter ablation (RFCA).

Methods

Forty-two patients undergoing PVI were prospectively analyzed (CBA, n = 28; RFCA, n = 14). Transthoracic echocardiography with speckle-tracking analysis was performed before PVI and at 12-month follow-up. LA size, volumetric indices (LAVI), strain components, and functional parameters were assessed.

Results

Patients undergoing CBA demonstrated greater increases in selected LA structural parameters during follow-up compared with RFCA. Repeated-measures ANOVA revealed a significant group-by-time interaction for LA diameter (p = 0.0017), while similar trends were observed for LAA (p = 0.0645) and LAS-R (p = 0.0547). No significant interaction effects were observed for LAVI-derived parameters or other indices of LA mechanical function.

Conclusions

In this preliminary exploratory study, CBA showed a tendency toward greater structural LA remodeling compared with RFCA during a 12-month follow-up. However, these findings should be interpreted with caution given the limited sample size and population heterogeneity. Larger prospective studies are warranted to validate these observations.