Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablation.

Fuqian Guo,Lan Yang,Rong Fu,Yang Jiao,Yuanyuan Meng,Chen Chen,Caiying Li,Jiqiong Ni,Yicheng Chen

doi:10.2459/jcm.0000000000001255

Abstract

To quantitatively investigate the impact of left atrial geometric remodeling on atrial fibrillation recurrence after catheter ablation. A retrospective analysis of 105 patients with atrial fibrillation who underwent coronary computed tomographic angiography before catheter ablation. Risk factors for atrial fibrillation recurrence were identified by multivariable logistic regression analysis and used to create a nomogram. After at least 12 months of follow-up, 30 patients (29%) developed recurrent atrial fibrillation. Patients with recurrence had higher left atrial volume, left atrial sphericity, and lower left atrial ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that left atrial minimal volume index (LAVImin) [odds ratio (OR): 1.026, 95% confidence interval (CI): 1.002-1.050, P = 0.034], left atrial sphericity (OR: 1.222, 95% CI: 1.040-1.435, P = 0.015) and CHADS2 score (OR: 1.511, 95% CI: 1.024-2.229, P = 0.038) were independent predictors of atrial fibrillation recurrence. The combined model of the left atrial sphericity to the LAVImin substantially increased the predictive power for atrial fibrillation recurrence [area under the curve (AUC) = 0.736, 95% CI: 0.627-0.844, P < 0.001], with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.772 (95% CI: 0.670-0.875) and had good internal validity. The CHADS2 score, left atrial sphericity, and LAVImin were significant and independent predictors of atrial fibrillation recurrence after catheter ablation. Furthermore, the nomogram had a better predictive capacity for atrial fibrillation recurrence.

Highlights

Atrial fibrillation (AF) is associated with a high risk of thromboembolic stroke, heart failure, and premature death
This study aimed to investigate whether left atrial (LA) geometric remodeling has a prognostic impact on AF recurrence after catheter ablation (CA) and to develop a precise predictive nomogram
There were no significant differences between the patients who experienced AF recurrence and those who did not in terms of age, sex, AF

Summary

Introduction

Atrial fibrillation (AF) is associated with a high risk of thromboembolic stroke, heart failure, and premature death. It is the commonest cardiac arrhythmia and is associated with high cost burdens on healthcare systems.[1] catheter ablation (CA) is a widely accepted treatment for drug-refractory AF with a success rate of 50%–80%,[2,3] AF recurrence remains an important issue. Various imaging modalities, including echocardiography, computed tomography (CT), and cardiac magnetic resonance imaging (CMRI), have been used to demonstrate the important role of left atrial (LA) geometry in assessing AF incidence.[4,5] Recent research has focused on precise assessments of the LA shape, which may prove to be a more precise marker than size alone.[6].

Objectives

Methods

Results

Discussion

Conclusion