부산대학교 도서관

Objective: to assess the effect of cryoballoon catheter ablation (CA) on left atrial (LA) volume (LAV), function and left ventricular diastolic function in patients with paroxysmal atrial fibrillation (PAF) during one year follow-up after CA.Patients: 36 patients selected for their first CA because of nonvalvular PAF (26 males, 57.4±8.9 yrs).Methods: in sinus rhythm transthoracic and tissue Doppler echo before, 3, 6 and 12 months after CA; transesophageal echo before CA was performed. LAV-s, LAV index (LAVI), mitral inflow parameters (E, A, DT), septal and lateral early- and late diastolic velocities of the mitral annulus (Ea, Aa), systolic (S) and diastolic (D) velocities, velocity-time integral (VTI) of the pulmonary vein flow (PVF) were measured. LA function was assessed by: Aasept, Aalat, LA filling fraction (LAFF=VTI A/VTI E+A), LA emptying fraction (LAEF=(LAVmax-LAVmin)/LAVmax), systolic fraction of PVF (PVSF=VTI S/VTI S+D), peak LA appendage emptying flow velocity (PLAAEFV). E, A, DT, Ea, E/Ea, S/D were used to evaluate diastolic function.Results: taking into account the first 3-month blanking period the success rate was 64%. During the one-year follow-up recurrent atrial arrhythmia was found in 21 patients (58%) on clinical / ECG / Holter /transtelephonic ECG. In the recurrent group 12 months after ablation minimal LAV (37.5±19.2 vs 43.9 ±19.6 ml; p<0.05), maximal LAV (72.9±23.4 vs 81.1±24 ml; p<0.05), LAVI (35.2±10.3 vs 39.2±10.7 ml; p=0.01) and max. LA longitudinal diameter (55±5 vs 59±6 mm; p<0.01) increased. PVSF (58.4±8.9 vs 50±10.2 %; p=0.01) and LAFF (36.4±6.9 vs 32.7±7.7 %; p=0.03) decreased. In the recurrent group LAEF was significantly lower at baseline and during the follow-up. E/Ea average, which was used to assess the filling pressure, increased in one year (7.2±1.8 vs 8.5±2.3 cm/s; p=0.005).Conclusions: In patients with PAF one year after CA in case of recurrence LA size increased, LA function declined and the filling pressure increased.