Abstract 18225: Left Atrial Volume Index and Outcomes in Paroxysmal Atrial Fibrillation (pAF) in the Real-AF Registry

Abstract

Introduction: Catheter ablation via pulmonary vein isolation Is one of the most commonly performed procedures for treating paroxysmal atrial fibrillation (pAF). Left atrium size affects ablation strategies and outcomes in patients with pAF. We analyzed the left atrium index (LAi) to determine associations with recurrent arrhythmias at 12 months post-ablation and the ablation strategies used. Methods: The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (pAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that is enrolling patients undergoing AF ablation at high-volume centers. Left atrial volume was reconstructed using CARTO 3D. LAi was separated into normal range: < 34 ml/m2, mildly enlarged 35 - 41 ml/m2, moderately enlarged 42 - 48 ml/m2, and severely enlarged > 49 ml/m2 based on the American Society of Echocardiogram guidelines. Ablation strategies were divided into pulmonary vein isolation (PVI) alone or PVI+ ablation, including PVI and additional atrial arrhythmogenic substrates. Recurrence of arrhythmias at 12 months post-ablation and ablation strategies were compared. Results: A total of 1824 were included. In patients with pAF 12.2% developed recurrent arrhythmia at 12 months. When compared to normal LAi, patients with pAF with moderately and severely enlarged LAi were more likely to have a recurrence of arrhythmias at 12 months (Table 1). Women with pAF and moderately and severely enlarged LAi were more likely to have recurrence of arrhythmias (Table 1). A total of 1433 underwent PVI only ablations, and 391 underwent PVI+ ablations. Abnormal LAi was also associated with patients undergoing PVI+ ablations compared to PVI only ablations (Table 1). Conclusions: In patients with pAF and abnormal LA size was associated with more recurrent arrhythmias at 12 months post-ablation. Patients with enlarged LAi were more likely to have PVI+ ablations.