Yonsei Med J.  2015 May;56(3):608-616. 10.3349/ymj.2015.56.3.608.

Left Atrial Function Following Surgical Ablation of Atrial Fibrillation: Prospective Evaluation Using Dual-Source Cardiac Computed Tomography

• Kim JB
• Yang DH
• Kang JW
• Jung SH
• Choo SJ
• Chung CH
• Song JK
• Lee JW

• KMID: 2450332
• DOI: http://doi.org/10.3349/ymj.2015.56.3.608

Abstract

PURPOSE
The Maze procedure has shown excellent efficacy in the elimination of atrial fibrillation (AF); however, little is known about the quality of functional recovery in the left atrium (LA) following successful sinus rhythm conversion by the Maze procedure.
MATERIALS AND METHODS
We prospectively enrolled 12 patients (aged 52.5+/-10.1 years, 1 female) with valvular AF undergoing mitral valve surgery combined with the Maze procedure. Parameters of LA function in three anatomic compartments [anterior, posterior, and LA appendage (LAA)] were evaluated using electrocardiography-gated dual-source cardiac CT at one month and at six months after surgery. Twelve subjects matched by age, gender, and body surface area served as controls.
RESULTS
At one month after surgery, ejection fraction (EF) and emptying volume (EV) of the LA were 14.9+/-7.4% and 21.3+/-9.7 mL, respectively, and they were significantly lower than those of the control group (EF, 47.9+/-11.2%; EV, 46.0+/-10.7%; p<0001). These values did not significantly change throughout late periods (p=0.22 and 0.21, respectively). Functional contributions of the anterior, posterior, and appendage compartments (EV of each compartment/overall EV) were 80.4%, -0.9%, and 20.5%, respectively, for those with LAA preservation (n=6); 100.1%, -0.1%, and 0% for those with LAA resection (n=6; p<0.05); and 62.2%, 28.2%, and 9.7% in the control subjects (p<0.001).
CONCLUSION
Contractile functions of the LA significantly decreased after the Maze procedure. Functional contributions of three compartments of the LA were also altered. The influence of LAA preservation on postoperative LA functions needs to be evaluated through studies of larger populations.

Keyword

Atrial fibrillation; ablation; surgery; left atrial systolic function

MeSH Terms

*Ablation Techniques
Adult
Aged
Atrial Appendage/*physiopathology
Atrial Fibrillation/physiopathology/*surgery
Atrial Function, Left/*physiology
Case-Control Studies
Electrocardiography/methods
Female
Heart Atria
Humans
Male
Middle Aged
Prospective Studies
Recovery of Function
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Three-dimensional measurement of LA volumes using volume-rendering imaging. Green demarcation lines indicate the extents of measurement for each compartment including (A), entire LA (right-anterior view); (B) LAA-extracted LA (right-anterior view); and (C) anterior compartment of the LA (right lateral view). RUPV, right upper pulmonary vein; LA, left atrium; LAA, left atrial appendage; RA, right atrium; LV, left ventricle; PA, pulmonary artery.

• 

  Fig. 2 Changes in overall LA volume at each time point. (A) Maximal volumes. (B) Minimal volume. LA, left atrium; LAA, left atrial appendage.

• 

  Fig. 3 LA contractile function at one and six months after surgery. (A) LA emptying volume. (B) LA ejection fraction. LA, left atrium; LAA, left atrial appendage.

• 

  Fig. 4 Booster functional contribution of each left atrial chamber (anterior, posterior, and LAA) at one and six months after surgery. LAA, left atrial appendage.

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