Prevalence and severity of left atrial edema detected by electron beam tomography early after pulmonary vein ablation

Prevalence and Severity of Left Atrial Edema Detected by Electron Beam Tomography Early After Pulmonary Vein Ablation Taro Okada, Takumi Yamada, Yoshimasa Murakami, Naoki Yoshida, Yuuichi Ninomiya, Takeshi Shimizu, Junji Toyama, Yukihiko Yoshida, Teruo Ito, Naoya Tsuboi, Takahisa Kondo, Yasuya Inden, Makoto Hirai, Toyoaki Murohara We demonstrated that left atrial (LA) edema was observed in a large portion of patients immediately after pulmonary vein (PV) ablation, often extending to regions remote from the PVs. The severity of the LA edema depended on the extent and amount of the radiofrequency energy delivered in the PV ablation. Although LA edema that was probably due to inflammation soon disappeared naturally and did not reduce cardiac function, an assessment by cardiac imaging at 1 month after the PV ablation may be useful to predict any complications of congestive heart failure even if such failure rarely occurs. Objectives The aim of this study was to investigate the prevalence and severity of left atrial (LA) edema after pulmonary vein (PV) ablation and its effect on the cardiac function. Background Though extensive LA catheter ablation has been demonstrated to be more effective in curing paroxysmal atrial fibrillation (PAF) than segmental ostial pulmonary vein isolation (S-PVI), it might cause life-threatening complications, including congestive heart failure associated with LA edema. Methods Fifty patients underwent S-PVI (Group S) and 27 underwent circumferential PV antrum ablation (Group C) for drug-refractory PAF. Enhanced electron beam tomography (EBT) was performed before, 1 or 2 days after, and 1 month after the PV ablation, and transthoracic ultrasound cardiography (UCG) was performed 1 month after the PV ablation in all patients. Results The EBT assessment revealed LA edema immediately after the PV ablation in 47 Group S patients and all Group C patients. The severity of the LA edema, number of radiofrequency applications, and amount of radiofrequency energy delivered during the PV ablation was significantly greater in Group C than in Group S. One month after the PV ablation, in all patients, the EBT assessment revealed that those edematous changes had disappeared, and the UCG assessment showed no reduction in the cardiac function. Conclusions Left atrial edema was observed in a large portion of the patients immediately after the PV ablation, and the severity of the LA edema depended on the extent and amount of the radiofrequency energy delivered in the PV ablation. The LA edema soon disappeared naturally and did not reduce the cardiac function.