Is the presence of left atrial diverticulum associated with recurrence in patients undergoing catheter ablation for atrial fibrillation?

Abstract

Introduction Catheter ablation (CA) for atrial fibrillation (AF) has been a major cornerstone in the management of AF. Despite promising advances in CA techniques, long-term results reveal a high rate of recurrence after the procedure. Left atrial diverticulum (LAD), a common anatomic variant of the left atrium, was previously shown to be associated with increased risk of thrombus formation, cardiac perforation and arrhythmia. In this study we aimed to investigate the relationship between LAD and recurrence in patients undergoing CA for AF. Material and methods A total of 100 consecutive patients with a mean age of 53 ±12.1 years (53% male) underwent radiofrequency (RF) (46, 46%) or cryoballoon (54, 54%) catheter ablation for atrial fibrillation preceded by cardiac computed tomography (CT) imaging. Clinical and procedural characteristics of the patients with and without AF recurrence were compared. Results Twenty-three (23%) patients had AF recurrence and 77 (77%) patients had no recurrence. The clinical parameters such as hypertension, diabetes mellitus, coronary artery disease and stroke did not differ between the groups. Left atrium diameter was significantly different between the two groups (4.1 ±0.5 vs. 3.9 ±0.5, p = 0.042). Presence of LAD was not different between the two groups (7 (31.8) vs. 21 (28.8); p = 0.794). Multivariate logistic regression analysis revealed RF ablation as the most important independent variable for AF recurrence (β = 3.115, p < 0.001, OR = 22.526, 95% CI: 4.287–118.351). Conclusions The presence of left atrial diverticulum is not associated with recurrence in patients undergoing RF and cryoballoon CA for atrial fibrillation.

Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques – incidence and risk factors

“…The distribution of factors potentially related to thromboembolic risk (comorbidities, LA diameter, persistent form of AF) was well balanced between the groups (Table I). Arterial hypertension was the most frequent comorbidity in all groups, which is consistent with other observations regarding the AF population [23][24][25][26][27]. The ablation procedure was performed with irrigated radiofrequency point-by-point technique (RF group) in 24 patients, and with 3 different single-shot techniques: a non-irrigated duty-cycled phased-RF catheter (PVAC) in 46 patients, a second-generation cryoballoon (CB) in 24 patients and with an irrigated multipolar RF catheter (nMARQ) in 10 patients.…”

Is there an association between left atrial outpouching structures and recurrence of atrial fibrillation after catheter ablation?

“…The main difference to our study is that two different types of ablation procedures were used (cryoballoon- and radiofrequency ablation) and the amount of rAF was significantly higher in the group that underwent radiofrequency ablation. Therefore we only included patients that underwent laser pulmonary vein isolation to avoid this possible bias [ 33 ]. However, none of these studies could prove LAD an independent risk factor for rAF.…”

Atrial fibrillation ablation: the position of computed tomography in pre-procedural imaging

“…Accordingly, some authors have observed that LAA volume (larger than 8.8ml according to Zheng et al, and >9.99 ml by Du et al) increases the likelihood of AF recurrences after antral RF ablation [40,41]. Furthermore, Patel et al and Demir et al demonstrated that 30,4% of all patients that underwent CT scan before ablation procedure had atypical left atrial anatomy (diverticula or accessory appendages) [42,43] (Fig. 2), while the wall of the left atrium diverticula (LAD) was much thinner than that of adjacent LA (0.89±0.46 versus 2.39±0.83 mm).…”