Abstract
Left atrial size in atrial fibrillation is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance multislice method (CMR-MSM) is the current gold standard for left atrial volume (LAV) assessment but is time consuming. We investigated whether LAV with more rapid area-length method by echocardiography (Echo-AL) or cardiac magnetic resonance (CMR-AL) and invasive measurement by 3D-CARTO mapping during ablation correlate with the CMR-MSM. We studied 250 consecutive patients prior to atrial fibrillation ablation. CMR images were acquired on 3T scanner to measure LAV by MSM and biplane area-length method. Standard echocardiography views were used to calculate LAV by biplane area-length method. LAV during ablation was measured by 3D-CARTO mapping. LAV was compared using intra-class correlation (ICC), Pearson’s correlation and Bland–Altman plots. CMR-MSM was used as the reference standard. Mean LAV using CMR-MSM was 112.7 ± 36.7 ml. CMR-AL method overestimated LAV by 13.3 ± 21.8 ml (11.2 %, p < 0.005) whereas 3D-CARTO and Echo-AL underestimated LAV by 8.3 ± 22.6 and 24.0 ± 27.6 ml respectively (8.7 % and 20.0 % respectively, p < 0.005). There was no significant difference between paroxysmal and persistent atrial fibrillation. CMR-AL and 3D-CARTO correlated and agreed well with CMR-MSM (r = 0.87 and 0.74, ICC = 0.80 and 0.77 respectively). However, Echo-AL had poor correlation and agreement with CMR-MSM (r = 0.66 and ICC = 0.48). Bland–Altman plots confirmed these findings. CMR-AL method may be used as an alternative to CMR-MSM, as it is non-invasive, rapid, and correlates well with CMR-MSM. LAV by different modalities should not be used interchangeably.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia
We sought to determine whether left atrial (LA) volume assessment using the more rapid area length (AL) method on transthoracic echocardiography (TTE), AL method on Cardiac magnetic resonance imaging (CMR), and invasive measurement by 3DCARTO electrophysiologic mapping correlated with CMR multiple slice method (MSM)
We prospectively studied 141 consecutive patients with AF from July 1, 2010 to July 31, 2011 prior to AF ablation (Table 1)
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Accurate assessment of left atrial (LA) volumes is imperative, as LA size is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance imaging (CMR) using the multiple slice method (MSM) is the current gold standard for volumetric analysis; it is time consuming. We sought to determine whether LA volume assessment using the more rapid area length (AL) method on transthoracic echocardiography (TTE), AL method on CMR, and invasive measurement by 3DCARTO electrophysiologic mapping correlated with CMR MSM
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