Are left ventricular ejection fraction and left atrial diameter related to atrial fibrillation recurrence after catheter ablation?

Abstract

Atrial fibrillation (AF), the most common form of arrhythmia, is associated with the prevalence of many common cardiovascular and cerebrovascular diseases. Catheter ablation is considered the first-line therapy for AF; however, AF recurrence is very common after catheter ablation. Studies have been performed to analyze the factors associated with AF recurrence, but none have reached a consistent conclusion on whether left ventricular ejection fraction (LVEF) and left atrial diameter (LA diameter) affect AF recurrence after catheter ablation.The databases PubMed, Embase, and the Cochrane Library were used to search for relevant studies up to September 2017. RevMan 5.3.5 software provided by the Cochrane Collaboration Network was used to conduct this meta-analysis.Thirteen studies involving 2825 patients were included in this meta-analysis. Overall, the results revealed that elevated LA diameter values were significantly associated with AF recurrence in patients after catheter ablation (MD = 2.19, 95% CI: 1.63–2.75, P < .001), while baseline LVEF levels were not significantly positively associated with AF recurrence in patients after catheter ablation (MD = −0.91, 95% CI: −1.18 to 1.67, P = .14).Overall, elevated LA diameter may be associated with AF recurrence after catheter ablation; however, there was no direct relationship between LVEF values and AF recurrence after catheter ablation when baseline LVEF values are normal or mildly decreased. Besides, because of publication bias, further studies should be performed to explore the mechanisms underlying AF recurrence.

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

“…However, age and related comorbidities are sufficient but not necessary to modify the atrial substrate in every patient within a short follow‐up period. However, such an arrhythmogenic mechanism could be predicted and revealed by LA size and AF type . This pathogenic mechanism explains why our study resulted in a nonsignificant difference in the rate of freedom from AF under the condition of different baseline characteristics, except for similar LA diameters and proportions of persAF.…”

“…Evidence also shows that advanced age (>60 years for the an arrhythmogenic mechanism could be predicted and revealed by LA size and AF type. 21,25 This pathogenic mechanism explains why our study As an evaluation of safety, both the peri-and post-procedural complication rates were comparable between the cohorts. Notably, the stroke (both ischemic and hemorrhagic) and major hemorrhagic event rates were similar in both cohorts.…”

The evolving landscape in the hybrid treatment of atrial fibrillation

“…Arguments favouring a staged approach are avoiding the logistic challenge of facilitating a single-procedure approach and the possibility of temporary (but not long-lasting) conduction block due to tissue oedema or inflammation. 25,66 The relevance of the latter argument, however, seems to be limited, since we found no difference in outcome between single and staged hybrid procedures. While overall success rates were higher after a hybrid procedure, Edgerton et al reported remarkably low success rates (20.8%).…”

“…Left atrial size was found to be a major determinant for recurrence of AF in different studies. 65,66 The duration and type of AF also negatively influence ablation outcomes. 65,67 Other predictors for failure are older age at time of ablation, female sex, higher CHA 2 DS 2 -VASc scores, obesity, obstructive sleep apnoea and chronic obstructive pulmonary disease.…”

“…63,64 A fairly new approach of ablating the center of rotors (FIRM ablation) also showed conflicting outcome, with some centers not being able to consistently demonstrate rotor reentry. [65][66][67][68] One reason for the inconsistent results and high failure rate in non-paroxysmal AF might be the limitation of the catheter devices to reliably create transmural linear lesions. 69 Incomplete lesions can be arrhythmogenic due to changes in conduction velocity and the possibility for reentry at the site of gaps.…”