Radiofrequency catheter ablation has proven effective in paroxysmal atrial fibrillation (AF) (1,2). Concerning persistent forms of atrial fibrillation, the rate of response to ablation is lower, leading to repeated procedures and increased RF delivery (3,4). Repercussions of extensive ablation on left atrial (LA) function over the long term can be awaited. The objective of this study was to report the structural and functional status of both atria years after successful ablation for persistent AF (PsAF), with the use of MRI.

Population 26 consecutive patients (age 54±8 years, 1 woman). Inclusion criterion : history of cardiac ablation for persistent AF using the stepwise approach with a minimum follow-up of 3 years since first procedure, and at least 1 year since last procedure without recurrence. Magnetic Resonance Imaging Cine imaging was performed to acquire: a stack of short axis slices covering the left ventricle (LV) from base to apex; a stack of 4 chambers slices covering both atria from roof to bottom; a modified 4-chamber plane comprising...

Baseline and follow-up characteristics Baseline characteristics are shown in Table 1. The number of procedures required to restore sinus rhythm without recurrence was 2.2±0.7. The cumulative duration of RF delivery over the procedures was 126±37 min. Mean follow-up since first procedure was 80±15 months. Follow-up characteristics are shown in Table 2. Scar extent was 29±6% in LA, and 4.3±2.8% in RA. LAEF, LAAEF, LAEI, and trans-mitral A wave peak were found impaired whereas RA function was found preserved. A wave was absent in 9/26 patients...

This study reports for the first time on the functional and structural status of both atria years after extensive ablation for persistent atrial fibrillation. LA contractility and compliance are markedly impaired years after successful PsAF ablation. LA dysfunction is closely related to scar burden. These findings indicate that even when sinus rhythm maintenance is achieved, extensive scarring of the LA wall is associated to significant functional impairment. Our results outline the need for a better definition of ablation targets in persistent AF, and a better...

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