Abstract
BackgroundAtrial fibrillation (AF) is the most common arrhythmia worldwide. Nowadays, AF ablation is a valuable treatment option. It has been shown that the left atrium (LA) diameter is a predictor of AF recurrence after cryoballoon ablation (CBA). Since it does not reflect the true LA size, we compared the role of different LA anatomical parameters using echocardiography for the prediction of AF recurrence after CBA.MethodsWe retrospectively included 209 patients (mean age 56.1 ± 13.6 years, male 62%) with paroxysmal AF undergoing CBA. A transthoracic echocardiography was performed in all patients.ResultsAt a mean follow-up of 16.9 ± 6.3 months, AF recurred in 25.4% of the patients. LA anterior - posterior diameter (LAD), LA minimum volume (LAmin) and early AF recurrence were independent predictors of recurrence. Based on receiver operating characteristics, cut – off values for LAD and, LAmin were 41 mm, 23.69 mL, respectively. The negative predictive values for recurrence were 73% and 87.3% respectively. In patients with AF recurrence, a significant proportion (30.2%) showed LA longitudinal remodeling (LA superior – inferior diameter) even though classically measured LAD was normal.ConclusionsLongitudinal LA remodeling plays an additional role for predicting AF recurrence after CBA, in patients without LAD dilation. Moreover, LAmin had a high negative predictive value and was an independent predictor of AF recurrence. Therefore, a more complete LA anatomical assessment allows a better prediction of AF recurrences after CBA.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia worldwide
There was a significant difference in patients with and without recurrence respectively for Left ventricular (LV) end-diastolic diameter (50.3 ± 7.9 mm vs. 47.2 ± 6.5 mm, p = 0.013), LV mass index (83.7 ± 28.4 g/m2 vs. 76.6 ± 26.3 g/m2, p = 0.045), LA anterior - posterior diameter (LAD) (42.2 ± 7.2 mm vs. 39 ± 6.1 mm, p = 0.013), LA maximum (LAmax) (67.3 ± 27.8 mL vs. 57.7 ± 21.2 mL, p = 0.036), LA minimum volume (LAmin) (36.7 ± 20.1 mL vs. 27.5 ± 14.9 mL, p = 0.004) and LAmin indexed (18.1 ± 9.3 mL/ m2 vs. 14.1 ± 7.4 mL/m2, p = 0.007)
The main findings of our study are: 1) recurrence of AF after the blanking period (BP) occurred in 25.4% of all subjects with paroxysmal AF. 2) In the group of patients with AF recurrence, longitudinal remodeling was present in patients with normal LAD. 3) In the global population of patients undergoing cryoballoon ablation (CBA), left atrium (LA) minimum volume was an independent predictor of AF recurrences after the BP
Summary
Atrial fibrillation (AF) is the most common arrhythmia worldwide. Nowadays, AF ablation is a valuable treatment option. It has been shown that the left atrium (LA) diameter is a predictor of AF recurrence after cryoballoon ablation (CBA). Since it does not reflect the true LA size, we compared the role of different LA anatomical parameters using echocardiography for the prediction of AF recurrence after CBA. Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing frequency worldwide, and it is associated with an elevated risk for stroke, heart failure and mortality. Several ablation strategies have proven to Recent data have shown that an increase of the left atrium (LA) anterior - posterior diameter (LAD) assessed by echocardiography is a powerful predictor of recurrence after CBA [4, 6]. We hypothesized that a more complete analysis of the LA dimensions could be a
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