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J Atr Fibrillation. 2013 Apr 6;5(6):788. doi: 10.4022/jafib.788. eCollection 2013 Apr-May.

Relationship of Ostial Pulmonary Vein Scar with Reduction in Pulmonary Vein Size after Radiofrequency Ablation for the Treatment of Atrial Fibrillation: An Observational Cohort Study.

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Harvard-Thorndike Laboratory of the Departments of Medicine and.
Yale University Medical School, New Haven, CT, Department of Medicine.
St. Elizabeth's Medical Center and Tufts Medical School, Boston, MA, Department of Medicine.
University of California - San Francisco, San Francisco, CA.
Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, Department of Medicine.


Background: Radiofrequency (RF) ablation procedures to electrically isolate the pulmonary veins (PV) from the left atrium are frequently used to treat atrial fibrillation. We hypothesized that changes in PV size after RF ablation would correlate with the volume of ostial PV scar as assessed by high resolution late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). Methods: The study cohort included 23 consecutive subjects. Contrast enhanced PV CMR angiography and LGE were obtained before and 42 ± 18 days after RF ablation. Results: A total of 85 PV were analyzed. Imaging after RF ablation demonstrated a reduction in PV diameter (22 ± 7 mm to 21 ± 6 mm, p = 0.001) and a reduction in cross-sectional area (CSA) (285 ± 141 to 246 ± 110, p < 0.001). There was a significant correlation of PV ostial normalized scar volume with the change in PV diameter (r =-0.21, p =0.049) and CSA (r =-0.28, p =0.010) after AF ablation. PV in the highest quartile for PV scar had the greatest reduction in diameter and CSA (p <0.05 for both). Conclusion: PV size decreases significantly after RF ablation for the treatment of AF. The change in PV size is linearly related to the quantity of LGE scar at the PV ostium.

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