AUTHOR=Karanasos Antonios , Tyrovolas Konstantinos , Tsiachris Dimitrios , Efremidis Michalis , Kordalis Athanasios , Karmpalioti Maria , Prappa Efstathia , Karagiannis Stefanos , Aggeli Constantina , Gatzoulis Konstantinos , Tousoulis Dimitrios , Tsioufis Costas , Toutouzas Konstantinos P. 

TITLE=Left Atrial Function Post Radiofrequency and Cryoballoon Ablation Assessed by Volume-Pressure Loops

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.830055

DOI=10.3389/fcvm.2022.830055

ISSN=2297-055X

ABSTRACT=Background: Left atrial (LA) function is linked to atrial fibrillation (AF) pathogenesis. AF catheter ablation decreases disease burden with potentially favourable effects on cardiac function. Atrial volume-pressure loops can optimally assess LA function.
Objective: To investigate changes in LA function by volume-pressure loops after paroxysmal AF ablation and explored potential differences between radiofrequency and cryoballoon ablation.
Methods: We analysed 44 patients undergoing paroxysmal AF ablation from 2 centres, 22 treated with radiofrequency and 22 with cryoablation. Pre- and post-procedure, all patients underwent real-time three-dimensional transthoracic echocardiogram to evaluate LA volume, while simultaneously recording LA pressure following transseptal puncture. Volume-pressure loops pre- and post-procedure were created by paired data. Areas of A-loop (LA booster pump function) and V-loop (LA reservoir function), and the stiffness constant determining the slope of the exponential curve during LA filling were calculated.
Results: Average LA pressure, A-wave and V-wave amplitude were increased post-procedurally (p<0.001). Overall, A-loop area decreased (p=0.001) and V-loop area tended to increase (p=0.07). The change in both A-loop and V-loop areas was similar between radiofrequency- and cryoballoon-treated patients (p=0.18 and p=0.52, respectively). However, compared to cryoballoon-treated patients, radiofrequency-treated patients had higher increase in the stiffness constant (b=0.059; 95%CI: 0.022-0.096;p=0.006).
Conclusion: AF catheter ablation by radiofrequency or cryoballoon is associated with decrease of the booster pump function and increase of the reservoir function. Moreover, there is a post-procedural increase of LA pressure which is associated with acute increase in LA stiffness in radiofrequency ablation, but not in cryoablation.