Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation

Abstract

Cryoballoon ablation (CBA) is a safe and efficient therapeutic option for atrial fibrillation (AF). However, AF recurrence occurs in 25% of the patients, leading to repeated ablations and complications. Previous reports have shown that left atrium (LA) assessed by M-Mode and two-dimensional echocardiography (2DE) predicts AF recurrence. Nevertheless, these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process. We hypothesized that LA remodeling by three-dimensional echocardiography (3DE) has an additional value for AF recurrence prediction post-CBA. 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively recruited. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. 50 (29%) patients had AF recurrence. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50,, p < 0.001). In patients with non-dilated LA diameter index and LAVI by 2DE, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m 2 . LA remodeling by 3DE predicted AF recurrence, even in patients with non-dilated LA by M-Mode and 2DE, suggesting that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and it should be considered for systematic use to evaluate AF recurrence risk post-CBA.

Evaluation of left atrial and ventricular remodeling in atrial fibrillation subtype by using speckle tracking echocardiography

“…Although there are several papers demonstrating the impact of AF on LA remodeling as well as the utility of LA size and function on AF recurrence prediction ( 29 – 31 ), our study shows that patients with PerAF had a higher degree of LA anatomical remodeling and functional impairment than that in patients with PAF, reflecting different stages of the disease. Moreover, LA reservoir strain could be a useful indicator in estimating cardiac function remodeling induced by AF even before LA volume dilation and showed better discriminative value than LAEF to separate AF from sinus rhythm patients.…”

Value of Imaging in the Non-Invasive Prediction of Recurrence after Catheter Ablation in Patients with Atrial Fibrillation: An Up-to-Date Review

“…Multiple studies have identified that a larger LA diameter [ 16 , 17 , 18 , 19 ] and volume [ 7 , 15 , 20 , 21 ] measured via transthoracic echocardiography before CA are associated with a higher probability of AF recurrence. Moreover, the LA volume index, calculated by dividing LA volume by body surface area, including the maximum, mean, minimum, and volume index, was relevant to AF recurrence after CA [ 22 , 23 , 24 ]. Studies have reported a significantly higher LA volume index in patients with AF relapse, attributing to the association between AF recurrence and poor LA structural remodeling [ 22 , 23 , 24 ].…”

“…Moreover, the LA volume index, calculated by dividing LA volume by body surface area, including the maximum, mean, minimum, and volume index, was relevant to AF recurrence after CA [ 22 , 23 , 24 ]. Studies have reported a significantly higher LA volume index in patients with AF relapse, attributing to the association between AF recurrence and poor LA structural remodeling [ 22 , 23 , 24 ]. A growing series of studies also claim an independent relationship between functional indices, such as left ventricular (LV) and LA ejection fraction, and the ratio of mitral inflow velocity to mitral annular tissue velocity (E/e’) and AF recurrence after CA [ 16 , 19 , 25 , 26 ].…”

“…A summary of studies using echocardiography to predict AF recurrence after CA is shown in Table 1 (Ref. [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 29 , 30 , 31 , 32 , 34 ]). Fig.…”