Effect of Repeated Radiofrequency Catheter Ablation o Atrial Function for the Treatment of Atrial Fibrillati Sílvia Montserrat, MD,Marta Sitges, MD,PhD*,Naiara Calvo, MD,Etelvino Silva, BMS, David Tamborero, BMS,Bàrbara Vidal, MD,PhD,Antonio Berruezo, MD,PhD,César Bernado, RN, Lluís Mont, MD,PhD,and Josep Brugada, MD, PhD Radiofrequency catheter ablation (RFCA) is a potential curative treatment for atrial fibrillation (AF) by eliminating the arrhythmia and inducing left atrial(LA) reverse remodeling. However, the effect on LA function, especially after repeated procedures scarcely been studied. The aim of this study was to evaluate the impact of RFCA on LA and function in patients with AF after a first and a repeated procedure. RFCA was performed in 154 patients with symptomatic drug-refractory AF. LA volumes and func were assessed with real-time 3-dimensional echocardiography before and 6 months after the procedure. Recurrence of the arrhythmia was defined as any atrial tachyarrhythmia lasting >30 seconds, clinically documented or by 24-hour Holter recording, after the first 6 months after ablation. Of the 154 patients, 104 (67%) required only a first ablation, 50 (33%) required redo RFCA. LA volume was reduced after first RFCA (from 60 ⴞ 19 t 52 ⴞ17 ml for 3-dimensional LA maximum volume, p <0.001, and from 38 ⴞ 18 to 33 ⴞ 15 mlfor 3-dimensional LA minimum volume, p <0.000) without impairment of LA contractile function, measured as the active emptying percentage of total volume (39 ⴞ 25% vs 43 ⴞ 26%, p ⴝ NS). After repeated RFCA procedures, 3-dimensional LA maximu volume was reduced (from 57 ⴞ 18 to 52 ⴞ 18 ml, p ⴝ 0.04),also without further LA contractile function impairment (active emptying percentage of total volume) (36 ⴞ 24 36 ⴞ 25% of total volume, p ⴝ NS). This effect was similar in paroxysmal and persisten AF. In conclusion, RFCA induces reductions in LA volumes without a deleterious impac on contractile function, even after repeated ablation. © 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;108:1741–1746) Radiofrequency catheter ablation (RFCA) is a potentially curative and safe invasive treatment of drug-refractory atrial fibrillation (AF). 1,2 Previous studies have described the ef- fects of RFCA on left atrial(LA) size,with reductions of LA dimensions and volumes 3– 8 and without a significant decrease in LA function, 3,7–13 mainly in those patients who maintain sinus rhythm (SR) (responders). 3– 8,10 Maintenance of LA function has clinical and therapeutic implications, because patients with impaired LA contractile function are at risk forAF recurrence and thromboembolism. Atrial systolic function could decrease after ablation procedures, depending of the size of the scar induced by the lines of radiofrequency application. 14,15 However, the impact of re- peated RFCA has not been extensively studied. Our aim was to evaluate, using real-time 3-dimensional (3D) echocardi- ography (RT3DE), 7,12,16 the impact of repeated RFCA on LA volumes and function, analyzing whether this effect differs between the first and second procedures. Methods A totalof 158 consecutive patients with symptomatic drug-refractory AF underwent RFCA and RT3DE before and 6 months after it. Of these, 107 patients (68%) under- wenta single RFCA procedure, and 51 (32%) required a secondprocedure. Repeatedprocedures wereindicated when patients persisted with symptomatic AF 3 month after a first ablation despite optimum pharmacologic tr ment.AF was paroxysmal in 50% of the patients and per sistent in the others (71% persistent and 29% long per [⬎1 year 17 ]). All patients gave written informed consent before echocardiographic studies and RFCA.The ethics committee of our institution approved the study protoc Standard2-dimensional and real-time3-dimensional transthoracic echocardiography were performed 24 to hoursbeforeRFCA. Transesophageal echocardiography was also performed on the same date to rule out throm the leftatrium. All images, obtained using a Philips iE33 ultrasound machine (Philips MedicalSystems, Andover, Massachusetts), were digitally stored and transferred to a workstation for off-line analysis. In 2-dimensional echo diographic examinations, LA diameters (anteroposterio ameter) and left ventricular dimensions were measured in the long parasternal axis,and the left ventricular ejection Cardiology Department, Thorax Institute, HospitalClinic,Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barce- lona,Barcelona, Spain. Manuscript received May 20, 2011; revised man- uscript received and accepted July 13, 2011. This work was supported in part by grants from the CENIT program of Centro de Desarrollo Tecnológico Industrial (cvREMOD project) and the Spanish government (REDINSCOR RD06/0003/0008). *Corresponding author: Tel: 34-932275509; fax: 34-932275509. E-mail address: msitges@clinic.ub.es (M. Sitges). 0002-9149/11/$ – see front matter © 2011 Elsevier Inc. All rights reserved. www.ajconline.org doi:10.1016/j.amjcard.2011.07.041