Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation

Costa, Francisco; Ferreira, António Miguel; Oliveira, Sílvia Marta; Santos, P Galvao; Durazzo, A; Carmo, Pedro; Santos, Katya Reis; Cavaco, Diogo; Parreira, Leonor; Morgado, Francisco; Adragão, Pedro

doi:10.1016/j.ijcard.2015.01.060

Cited by 69 publications

(38 citation statements)

References 37 publications

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“…Moreover, two other studies demonstrated the presence of LVZs in patients with paroxysmal and persistent AF, and in both studies, a targeted LVZ ablation strategy resulted in improved outcomes independent of AF pattern 7,31 . Although patients with paroxysmal AF typically have better ablation outcomes compared to those with persistent AF, in a large prospective study, CT‐LAVI was the strongest predictor of AF recurrence after PVI, followed by female sex, AF pattern, and age 32 . Furthermore, other groups have shown that female sex, age, and LA dimensions (2D echo‐derived LA area or EAVM‐derived surface area) were able to predict the presence of LVZs, and that this was associated with a significantly lower bipolar amplitude of the LA compared to patients without LVZs 33,34 …”

Section: Discussionmentioning

confidence: 94%

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Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

Sante

Romano

Alothman

et al. 2020

Cardiovasc electrophysiol

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Background Pulmonary vein isolation is the cornerstone of catheter ablation in patients with atrial fibrillation (AF). However, with advanced left atrial (LA) structural changes, additional targeted catheter ablation of low‐voltage zones (LVZs) has produced favorable results. Therefore, with the advent of single‐shot techniques, it would be helpful to predict the presence of LVZs before an ablation procedure. Objective We hypothesized that computed tomography (CT)‐derived left atrial volume index (LAVI), in combination with other objective parameters, could be used to develop a score able to predict the presence of LVZs. Methods In a large cohort of patients undergoing their first AF ablations, comprehensive echocardiographic evaluations and cardiac CT were performed. During the electrophysiological studies, LA geometry and electroanatomic voltage maps were created. LVZs were defined as areas ≥1 cm2 with bipolar peak‐to‐peak voltage amplitudes ≤0.5 mV. Results In a derivation cohort of 374 patients, predictors of LVZs were identified by regression analysis and used to build the Zentralklinik Bad Berka and University of L'Aquila (ZAQ) score (age ≥65 years; female sex; and CT‐LAVI ≥57 mL/m2). The ZAQ score of 2 points accurately identified the presence and the extent of LVZs (area under the curve [AUC], 0.809; 95% confidence interval [CI], 0.758‐0.861; P < .001 and 3 [interquartile range, IQR, 1.5‐4.5] vs 7 cm2 [IQR 4‐9]; P = .001). In a validation cohort of 103 patients, the predictive value of the score was confirmed (AUC, 0.793; 95% CI, 0.709‐0.878; P < .001 and 4 [IQR, 2‐7] vs 11.5 cm2 [IQR, 8‐16.5]; P = .001). Conclusions The ZAQ score identifies LVZs and may be useful for planning the ablation strategy ahead of time.

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Section: Discussionmentioning

confidence: 94%

“…7,31 Although patients with paroxysmal AF typically have better ablation outcomes compared to those with persistent AF, in a large prospective study, CT-LAVI was the strongest predictor of AF recurrence after PVI, followed by female sex, AF pattern, and age. 32…”

Section: Discussionmentioning

confidence: 99%

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

Sante

Romano

Alothman

et al. 2020

Cardiovasc electrophysiol

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“…Kim et al reported that pericardial fat volume is associated with clinical recurrence after catheter ablation for persistent atrial fibrillation, but not paroxysmal atrial fibrillation 44 . Another study by Costa FM et al revealed that left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation 45 . In the current study, the follow up duration for AF recurrence was relatively short, therefore, further study is necessary to investigate whether LV native T 1 time is useful to predict AF occurrence in long term follow up period after PVI.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular native T1 time and the risk of atrial fibrillation recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Kato

Foppa

Roujol

et al. 2016

International Journal of Cardiology

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Background Native T1 mapping has emerged as a noninvasive non-contrast magnetic resonance imaging (MRI) method to assess for diffuse myocardial fibrosis. However, LV native T1 time in AF patients and its clinical relevance are unclear. Methods Fifty paroxysmal AF patients referred for PVI (60±8 years, 37 male) and 11 healthy control subjects (57±8 years, 10 male) were studied. All patients were in sinus rhythm during the MRI scan. Native T1 mapping images were acquired using a Modified Look-Locker imaging (MOLLI) sequence in 3 short-axis planes (basal, mid and apical slices) using an electrocardiogram triggered single-shot acquisition with a balanced steady-state free precession readout. Late gadolinium enhanced (LGE) MRI was acquired to evaluate for LV myocardial scar. Results LV ejection fraction was similar between groups (AF: 61±6%; controls: 60±6%, p=0.75). No LV myocardial scar was observed in any patient on LGE. Myocardial native T1 time was greater in AF patients (1099±52 vs 1042±20 msec, p<0.001). During a median follow-up period of 326 days, 18 of 50 (36%) patients experienced recurrence of AF. Multivariate Cox proportional hazard analysis identified elevated native T1 time as an independent predictor of recurrence of AF (HR: 6.53, 95% CI: 1.25–34.3, p=0.026). Conclusions There are differences in the native LV myocardial T1 time between AF patients with preserved LV function referred for PVI and normal controls. Native T1 time is an independent predictor of recurrence of AF after PVI in patients with paroxysmal AF.

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“…CMR data are presented in Table II [11][12][13][14][15][16][17][18] mL, P < 0.001) and LA-AEF (13 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs 32 [26-36] %, P < 0.001) were significantly lower in the SM group compared to the CG.…”

Section: Cmrmentioning

confidence: 99%

“…Active left and right (RA) atrial emptying fractions (AEF) as well as peak active left atrial appendage (LAA) emptying velocities were obtained by CMR flow measurements. Furthermore, LA scar burden was quantified on electroanatomical voltage maps by the portion of points with local voltage amplitude <0.2 mV.Results: We found median LA-AEF to be lower (13 [9-22] vs 32 [26][27][28][29][30][31][32][33][34][35][36] %, P < 0.001) and median LA scar burden to be higher (40 [20-68] vs nine [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] %, P < 0.05) in the SM group compared with the CG. Furthermore, a significant correlation was found between mean LA voltage and LA-AEF (r 2 = 0.62, P < 0.001).…”

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confidence: 99%

Active Atrial Function and Atrial Scar Burden After Multiple Catheter Ablations of Persistent Atrial Fibrillation

Nührich¹,

Geisler²,

Steven

et al. 2017

Pacing Clinical Electrophis

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Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation

Cited by 69 publications

References 37 publications

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

Left ventricular native T1 time and the risk of atrial fibrillation recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Active Atrial Function and Atrial Scar Burden After Multiple Catheter Ablations of Persistent Atrial Fibrillation

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