Abstract
BackgroundAdvanced atrial fibrillation (AF) patients have persistent AF, failed previous catheter ablation and/or an enlarged left atrium (LA), which is associated with a reduced success of AF ablation. Transthoracic echocardiography (TTE) and contrast enhanced magnetic resonance angiography (CE-MRA) are available to assess LA volume. However, it is unknown how these modalities relate in patients with advanced AF. We therefore compared the reproducibility of TTE and non-triggered CE-MRA in advanced AF patients and their ability to select patients with successful thoracoscopic AF ablation.MethodsTwo independent observers measured LA volumes on 65 TTE and CE-MRA exams of advanced AF patients prior to AF ablation. Patients were followed after AF ablation with rhythm monitoring every 3 months for 1 year to determine AF recurrence. Inter-modality, inter- and intra-observer variability were determined using intraclass correlation coefficients (ICC). Receiver-operating characteristic (ROC) analysis was performed to determine sensitivity and specificity of TTE and CE-MRA volume and CE-MRA dimensions to identify patients with AF recurrence during follow-up.ResultsLA enlargement ≥ 34 ml/m2 was present in 60% of the patients. CE-MRA and TTE demonstrated a good correlation for LA volume assessment (intraclass correlation, ICC = 0.86; p < 0.001) with larger volumes consistently measured by CE-MRA. Major discrepancies were mostly attributed to TTE acquisition. Craniocaudal enlargement discriminated patients with AF recurrence (AUC 0.67 [95% CI 0.55–0.85], p = 0.01).ConclusionsNon-triggered CE-MRA is a viable and reproducible 3D alternative for 2D TTE to assess LA volume in advanced AF patients. Craniocaudal enlargement was the only discriminator of AF recurrence after AF ablation.
Highlights
Advanced atrial fibrillation (AF) patients have persistent AF, failed previous catheter ablation and/or an enlarged left atrium (LA), which is associated with a reduced success of AF ablation
While pulmonary vein isolation (PVI) continues to emerge as effective strategy for AF treatment, adequate assessment of LA volume becomes increasingly important for the selection of patients for AF ablation, but may be hampered by a lack of sinus rhythm and asymmetrical enlargement in advanced AF patients [1, 2, 4]
We performed a cross-sectional comparison of transthoracic echocardiography (TTE) and contrast enhanced magnetic resonance angiography (CE-MRA) exams made during standard work-up for AF ablation surgery and followed patients for one year to determine success of the procedure
Summary
Advanced atrial fibrillation (AF) patients have persistent AF, failed previous catheter ablation and/or an enlarged left atrium (LA), which is associated with a reduced success of AF ablation. Transthoracic echocardiography (TTE) and contrast enhanced magnetic resonance angiography (CE-MRA) are available to assess LA volume. It is unknown how these modalities relate in patients with advanced AF. While PVI continues to emerge as effective strategy for AF treatment, adequate assessment of LA volume becomes increasingly important for the selection of patients for AF ablation, but may be hampered by a lack of sinus rhythm and asymmetrical enlargement in advanced AF patients [1, 2, 4]. TTE is unable to detect asymmetry or pronounced unidirectional atrial enlargment [6,7,8]
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