Impact of stand-alone minimally invasive radiofrequency ablation with left atrial appendectomy on left atrial function assessed by echocardiography

摘要

Background: Stand-alone minimally invasive radiofrequency (RF) ablation with left atrial (LA) appendectomy has been an effective surgical intervention for non-paroxysmal atrial fibrillation (AF) (NPAF) in patients with a medical history of thromboembolism for secondary stroke prevention. This study sought to assess the impact of this surgery on LA function. Methods: A total of 37 NPAF patients with a medical history of stroke or thromboembolism were enrolled in this prospective observational study, all of whom underwent stand-alone minimally RF ablation with LA appendectomy. Echocardiography was used to evaluate LA function preoperatively and 1 week and 3 months postoperatively. All patients were divided into two groups (Group AF and Group SR) according to whether sinus rhythm (SR) was restored after the surgery. Results: The surgery had no impact on LA function in Group AF. Once NPAF patients were restored to SR, LA minimal volume (LAVmin) decreased immediately compared with pre-operation (22.98±13.76 vs. 17.68±9.52 mL; P0.05) and consequently LA reservoir function increased, including LAEF (37.69%±12.53% vs. 46.71%±8.53%, P0.05) and LAEI (66.54%±34.39% vs. 92.15%±31.37%, P0.05). PA-TDI of Group SR, indicating LA electromechanical coupling, were improved at three months of follow-up because of atrial stunning after the surgery (160.55±26.19 vs. 143.82±20.923 ms, P0.05). LA contractile function was also improved at three months of follow-up (A-TVI: 2.95±1.16 vs. 5.10±1.85 cm, P0.05). Conclusions: Stand-alone minimal invasive RF ablation with LA appendectomy had no impact on LA function in AF patients who could not be restored to SR. However, once AF patients were restored to SR after the surgery, LA function could recover better. Meanwhile, thromboembolic events could also be reduced after the surgery.