Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis

Njoku, Augustine; Kannabhiran, Munish Kumar; Arora, Rishi; Reddy, Pratap; Gopinathannair, Rakesh; Lakkireddy, Dhanunjaya; Dominic, Paari

doi:10.1093/europace/eux013

Cited by 300 publications

(241 citation statements)

References 35 publications

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“…LA diameter >41 mm and LAVI >36 ml/m 2 were detected as cut-off values. These findings are in line with current analyses showing that left atrial enlargement is a negative predictor of successful restoration of the sinus rhythm following rhythm control attempt (23,24). Concordant to our observations, Akdemir et al, have detected the same cut-off value for LAVI in patients following CV (23), while other investigations have stated lower values for LAVI as significant (25)(26)(27).…”

Section: Discussionsupporting

confidence: 93%

Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume Index

Kranert

Shchetynska-Marinova

Liebe

et al. 2020

In Vivo

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Background/Aim: Despite advances in the treatment strategies of patients with atrial fibrillation (AF), the risk of AF recurrences is still over 50%. An increased left atrial volume index (LAVI) reflects left ventricular diastolic dysfunction (DD) and deterioration of the LA function. This study aims to determine AF recurrence following cardioversion (CV) or catheter ablation for AF (pulmonary vein isolation; PVI) in dependence of DD and LAVI. Patients and Methods: One hundred and sixty-two patients with paroxysmal or persistent AF in whom either CV or PVI were performed were included and followed over a mean of 22.9±3.8 months.Recurrence was defined as any recurrence of AF that occurred 3 months following the procedure. DD and LAVI were assessed using transthoracic echocardiography (TTE). Results: Recurrent AF occurred in 100 (61.7%) patients, predominantly following CV [CV 41 (76.2%) vs. PVI 59 (54.6%), p<0.0001]. Both DD and an increased LAVI were more common in the recurrence-group [DD 46.0% vs. 14.5%, p=0.0001; LAVI (ml/m 2 ) 49.0±18.6 vs. 26.3±7.0, p<0.0001]. ROC analysis revealed LAVI>36 ml/m 2 as AUC=0.92, sensitivity=76%, specificity=94%). In the multivariate analysis, DD (HR=1.6, p=0.04) and LA enlargement (defined as LAVI>36 ml/m 2 with HR=2. 1, p<0.0001) could be identified as independent predictors of AF recurrence after attempting to control the heart rhythm. Conclusion: LA enlargement and DD are independent risk factors associated with AF recurrence after initial successful rhythm control attempt. These findings have implications for timing of either ablation or CV.

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Section: Discussionsupporting

confidence: 93%

Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume Index

Kranert

Shchetynska-Marinova

Liebe

et al. 2020

In Vivo

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“…LAVI provided a more accurate assessment of LA remodeling, and is known to be independently associated with AF recurrence after cardioversion or catheter ablation. [22][23][24] In healthy subjects, LAVI is not influenced by age, 25 is closely related to diastolic dysfunction, and is a powerful predictor of AF as well as other cardiovascular events. 26 In the absence of LVZs, patients with persistent AF undergoing PVI alone have clinical outcomes comparable to those with paroxysmal AF, 27 and, in a recent study, the efficacy of cryoballoon ablation in paroxysmal and persistent AF was equivalent when LAVI was less than 61 mL/m 2 .…”

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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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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“…Previous studies have revealed that LA structural reverse remodeling following AFCA predicts a lower long-term AF recurrence rate 16 and may improve patients' prognosis. 14,17 Whether similar conclusions can be reached after one-stop treatment still relies on long-term follow-up results.…”

Section: Simple Linear Regression Analysismentioning

confidence: 99%

Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

Gong

Zhao

et al. 2019

Cardiovasc electrophysiol

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Introduction Catheter ablation of atrial fibrillation (AFCA) and left atrial appendage closure (LAAC) exert opposite effects on left atrial (LA) size. We aim to observe the net impact of combined AFCA and LAAC strategy on LA size and explore those factors which might affect the postprocedure LA structural remodeling. Methods A total of 53 patients, who underwent combined AFCA and Watchman LAAC in our center from March to December 2017, were enrolled. Atrial fibrillation (AF) recurrence was monitored after the procedure. Left atrial volume (LAV) and left atrial appendage volume (LAAV) were measured by Mimics based on dual‐source computed tomography images. Results At 6 months, sinus rhythm (SR) was maintained in 79.2% patients. LAV was significantly reduced (130.2 ± 36.3 mL to 107.1 ± 30.0 ml; P < .001) in SR maintenance group, but not in AF recurrence group (138.8 ± 39.3 mL to 137.9 ± 36.9 mL; P = .671). In SR group, preoperative LAAV/LAV ratio (B = −0.894; P = .015), NT‐proBNP (B = 0.005; P = .019) and left ventricular ejection fraction (LVEF) (B = −0.778; P < .001) could interactively affect the extent of postoperative LA structural reverse remodeling, among which LAAV/LAV ratio could independently predict the significance of reverse remodeling (≥15% reduction in LAV) (OR, 0.56; 95% CI, 0.34‐0.90; P = .018). A preoperative LAAV/LAV ratio less than 7.1% is indicative of significant LA structural reverse remodeling in this patient cohort. Conclusions LA structural reverse remodeling could be evidenced in patients with maintained SR following combined AFCA and LAAC. Smaller LAAV/LAV ratio, higher NT‐proBNP or lower LVEF at baseline are associated with more significant LA structural reverse remodeling, while LAAV/LAV ratio can predict the significance of the process after one‐stop treatment.

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Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis

Abstract: Patients with AF recurrence following RFA have a higher mean LAV/LAVi compared to patients with no recurrence. Large LAV/LAVi increases the odds of AF recurrence post RFA.

Cited by 300 publications

References 35 publications

Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume Index

Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume Index

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

Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

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