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. 2022 Mar 9:9:830055.
doi: 10.3389/fcvm.2022.830055. eCollection 2022.

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

Antonios Karanasos  1 , Konstantinos Tyrovolas  2 , Dimitrios Tsiachris  3 , Michalis Efremidis  2 , Athanasios Kordalis  1   3 , Maria Karmpalioti  1 , Efstathia Prappa  2 , Stefanos Karagiannis  3 , Constantina Aggeli  1 , Konstantinos Gatzoulis  1 , Dimitrios Tousoulis  1 , Costas Tsioufis  1 , Konstantinos P Toutouzas  1
Affiliations

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

Antonios Karanasos et al. Front Cardiovasc Med. .

Abstract

Background: Left atrial (LA) function is linked to atrial fibrillation (AF) pathogenesis. AF catheter ablation decreases disease burden with potentially favorable effects on cardiac function. Atrial volume-pressure loops can optimally assess the LA function.

Objective: To investigate changes in LA function by volume-pressure loops after paroxysmal AF ablation and explored potential differences between the radiofrequency and cryoballoon ablation.

Methods: We analyzed 44 patients undergoing paroxysmal AF ablation from 2 centers, 22 treated with radiofrequency and 22 with cryoablation. Pre- and post-procedure, all patients underwent a real-time three-dimensional transthoracic ECG 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 amplitude, 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 with 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 the radiofrequency or cryoballoon is associated with the 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 an acute increase in LA stiffness in radiofrequency ablation, but not in cryoablation.

Keywords: atrial fibrillation; catheter ablation—atrial fibrillation; left atrium; real-time three-dimensional echocardiography; volume pressure loops.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Methodology of echocardiographic analysis for left atrial (LA) volume calculation. (B) Simultaneous recording of LA pressure and LA volume during a cardiac cycle gated by ECG. (C) Graphical plotting of LA volume vs. LA pressure and creation of volume pressure loops. (D) Calculation of the passive elastic chamber stiffness constant (cm−3) and of the elastic constant (mmHg).
Figure 2
Figure 2
Study flow diagram.
Figure 3
Figure 3
Representative examples of changes in LA volume-pressure loops in patients undergoing transcatheter atrial fibrillation (AF) ablation with (A) radiofrequency catheter and (B) cryoballoon.
See this image and copyright information in PMC

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