Evaluation of left atrial appendage isolation using cardiac MRI after catheter ablation of atrial fibrillation: Paradox of appendage reservoir

Hyungjoon Cho, Yongwon Cho, Jaemin Shim, Jong Il Choi, Young Hoon Kim, Yu Whan Oh, Sung Ho Hwang

Research output: Contribution to journalArticlepeer-review


Objective: To assess the effect of left atrial appendage (LAA) isolation on LAA emptying and left atrial (LA) function using cardiac MRI in patients who underwent successful catheter ablation of atrial fibrillation (AF). Materials and Methods: This retrospective study included 84 patients (mean age, 59 ± 10 years; 67 males) who underwent cardiac MRI after successful catheter ablation of AF. According to the electrical activity of LAA after catheter ablation, patients showed either LAA isolation or LAA normal activity. The LAA emptying phase (LAA-EP, in the systolic phase [SP] or diastolic phase), LAA emptying flux (LAA-EF, mL/s), and LA ejection fraction (LAEF, %) were evaluated by cardiac MRI. Results: Of the 84 patients, 61 (73%) and 23 (27%) patients showed LAA normal activity and LAA isolation, respectively. Incidence of LAA emptying in SP was significantly higher in LAA isolation (91% vs. 0%, p < 0.001) than in LAA normal activation. LAA-EF was significantly lower in LAA isolation (40.1 ± 16.2 mL/s vs. 80.2 ± 25.1 mL/s, p < 0.001) than in LAA normal activity. Furthermore, LAEF was significantly lower in LAA isolation (23.7% ± 11.2% vs. 31.1% ± 16.6%, p = 0.04) than in LAA normal activity. Multivariate analysis demonstrated that the LAA-EP was independent from LAEF (p = 0.01). Conclusion: LAA emptying in SP may be a critical characteristic of LAA isolation, and it may adversely affect the LAEF after catheter ablation of AF.

Original languageEnglish
Pages (from-to)525-534
Number of pages10
JournalKorean journal of radiology
Issue number4
Publication statusPublished - 2021 Apr

Bibliographical note

Funding Information:
Received: May 15, 2020 Revised: July 22, 2020 Accepted: August 8, 2020 This research was technically supported by the Korea University Anam Imaging Data (AID) Bank. This research was supported by a grant from Korea University Anam Hospital, Seoul, Republic of Korea (Grant No. O1700361). Corresponding author: Sung Ho Hwang, MD, PhD, Department of Radiology, Korea University Anam Hospital, 73 Goryeodae-ro, Seoungbuk-gu, Seoul 02841, Korea. • E-mail: sungho.hwng@gmail.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Publisher Copyright:
© 2021 The Korean Society of Radiology.


  • Atrial fibrillation
  • Catheter ablation
  • Left atrial appendage
  • Left atrium
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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