Abstract 13231: Atrial Fibrillation Recurrence After Catheter Ablation is Associated With Left Atrial Appendage Volume and Plasma Docosahexaenoic Acid Levels

Abstract

Background: Risk factors for atrial fibrillation (AF) recurrence in patients undergoing catheter ablation (CA) are unclear. We assessed whether left atrium (LA) and LA appendage (LAA) volume, cardio-metabolic markers such as oxidative and glycation stresses, endothelial function, and polyunsaturated fatty acids (PUFAs) levels were associated with AF recurrence. Methods: Seventy-seven consecutive patients with AF undergoing first-time CA (mean age, 59 ± 8 years; male, 81%; paroxysmal AF, 65%; chickenwing morphology, 49%) were enrolled. LA, LAA volume, and morphology were measured using 3D-computed tomography. Measurements of skin auto-fluorescence advanced glycation end-products (AGEs), circulating PUFAs, and vascular function using EndoPAT were performed immediately before CA. Results: Patients with AF recurrence (36%) had larger LAA volumes (19 ± 13 vs 14 ± 4 cm 3 , P = 0.04) and a larger LAA orifice area (4.9 ± 2.0 vs 3.2 ± 2.1 cm 2 , P = 0.001) than those without AF recurrence, whereas LA diameter and LA volumes were not significantly different. NT-proBNP levels were significantly higher in patients with AF recurrence (527 ± 604 vs 245 ± 268 pg/mL, P = 0.03) than in those without AF recurrence. Notably, AF recurrence occurred in all patients (n = 5) with giant LAAs (≥25 mL). There were no differences in AGEs or vascular function between patients with and without AF recurrence. LAA volume was significantly and negatively associated with docosahexaenoic acid (DHA) levels (P = 0.006, r = –0.32), and patients with giant LAAs (≥25 mL) had significantly lower levels of DHA than other patients (107 ± 36 vs 157 ± 46 μg/mL, P = 0.04). Multiple regression analysis determined that log NT-proBNP and plasma DHA levels were independent factors for LAA volume (P = 0.03, P = 0.02, respectively), when adjusted for age, left ventricular (LV) ejection fraction, LV diameter at end systole, AF detected age, log NT-proBNP, plasma EPA, and DHA levels. Conclusions: A large LAA volume and higher NT-proBNP levels were associated with AF recurrence after CA; AF recurred in all patients with giant LAAs (≥25 mL). Moreover, low levels of DHA were associated with a large LAA volume. Thus, the association between LAA volume and low plasma DHA levels may be an important factor for post-CA AF recurrence.