Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation

Bary, Christian von; Dornia, Christian; Eissnert, Christoph; Nedios, Sotirios; Roser, Mattias; Hamer, Okka W.; Gerds‐Li, Jin‐Hong; Paetsch, Ingo; Jahnke, Cosima; Gebker, Rolf; Weber, Stefan; Fleck, Eckart; Kriatselis, Charalampos

doi:10.1007/s10840-011-9641-6

Cited by 39 publications

(21 citation statements)

References 27 publications

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Section: Discussionmentioning

confidence: 99%

“…Large left atrial (LA) size was found to be a predictor of recurrence of AF after electrical or pharmacological cardio-version as well as after ablative treatment [14][15][16][17]. The prognostic value of volume seems to be absent in AFparox, however [18].LA function comprises three phases: reservoir, conduit and active contraction phase [19]. LA-active function increases with slight volume load as long as LA structural dilatation is limited [19,20].…”

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2013

J Cardiobiol

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Purpose: Pulmonary vein isolation (PVI) is established as interventional treatment in atrial fibrillation (AF). Recent studies suggest that atrial reservoir function (preload) is involved in initiation of paroxysmal AF (AFparox) and conduit function (after-load) may be crucial in persistent AF (AFpers). Methods:We enrolled 336 consecutive patients scheduled for PVI (age 60±10 years). Point-to-point radiofrequency ablation was used in the majority of cases. Success was defined as a minimum of 3 months (median 12 months) follow-up as absence of recurrence of AF in any Holter ECG since PVI. in particular pulmonary vein isolation (PVI), can be considered as an early option in the management of patients with AF [5]. Success rates of the initial ablation procedure depend on the definition of success; they vary between 60 and 85% for AFparox and are lower for persistent AF (AFpers) [3,[6][7][8][9].The initiation of AF requires both a trigger and a susceptible substrate. In recurrent AFparox ectopic focal activity is thought to be local and limited to one or a few sites. On the contrary in AFpers there tend to be multiple ectopic sites throughout the atria and advanced damage of atrial myocardium (more susceptible substrate) [10][11][12][13]. Large left atrial (LA) size was found to be a predictor of recurrence of AF after electrical or pharmacological cardio-version as well as after ablative treatment [14][15][16][17]. The prognostic value of volume seems to be absent in AFparox, however [18].LA function comprises three phases: reservoir, conduit and active contraction phase [19]. LA-active function increases with slight volume load as long as LA structural dilatation is limited [19,20]. Thus, in early LA dysfunction as expected in AFparox systolic LA dimensions are ambiguous, because an increased systolic volume may reflect increased loading and/or size (history of dilatation).Recent studies suggest that preserved atrial reservoir function related to preload is a predictor of success [21]. Impairment of atrial reservoir function and poor long-term success of PVI in small left atria was related to enhanced fibrosis [22]. Whereas conduit function related to after-load may become increasingly important for PVI success in large atria with poor emptying.Thus, we tested the hypothesis that in AFparox atrial reservoir function and in AFpers residual conduit function is crucial for success of PVI by an analysis in the function-size plane in a retrospective study in our PVI data-base. As second end points we wanted to identify echocardiographic parameters potentially predicting recurrence of AF after PVI and elucidate the impact of body mass index (BMI) in this context.

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Section: Discussionmentioning

confidence: 99%

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Untitled

2013

J Cardiobiol

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“…The reported predictors of recurrence after ablation are the presence of hypertension, long duration of AF, prolonged procedural time, enlarged LA diameter (LAD), or increased LA volume (LAV) and decreased LA function. [4][5][6][7][8][9] However, there is no consensus regarding the risk factors for recurrence because of heterogeneities in the study population, differences in the follow-up period, and differences in the type of AF.Echocardiography has a well-recognized and essential role in the current guidelines for the assessment of cardiac structure and function in patients with AF.10) Several echocardiographic parameters for predicting the maintenance of SR after cardioversion, including LA size, mitral A wave velocity, and left atrium and LA appendage (LAA) mechanical function 11-13) have been reported. However, these echocardiographic predictors of AF recurrence have only been evaluated during a relatively short-term follow-up period.…”

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The Difference of Predictors for Recurrence After Catheter Ablation of Non-Paroxysmal Atrial Fibrillation According to Follow-Up Period

et al. 2014

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SummaryThe aim of this study was to assess the clinical and echocardiographic predictors for the recurrence of persistent atrial fibrillation (AF) after ablation during a long-term period.A total of 130 patients with persistent AF who had undergone radiofrequency catheter ablation (RFCA) were enrolled. We analyzed the relation between clinical parameters, echocardiographic parameters, and AF recurrences at 6 months, 1 year, and 2 years after ablation.During the 2-year follow-up, AF recurred in 61 patients (46.6%). In the 6 month follow-up, AF recurrence was associated only with total ablation time only. However, during the 1-year and 2-year follow-up periods, the presence of hypertension, impaired left atrial (LA) emptying fraction (eF) (≤ 20%), decreased LA appendage (LAA) emptying velocity (≤ 20 cm/sec), and LAAeF (≤ 20%) were correlated with AF recurrence (odds ratio [OR] = 1.87, 2.45, 1.93, and 2.15 respectively, P = 0.016, 0.004, 0.029, and 0.004 respectively). Among these factors, impaired LAeF was the only independent predictor of AF recurrence in multivariate analysis (OR = 2.81, P = 0.012).In patients with persistent AF who had undergone RFCA, the best predictor of AF recurrence after ablation varied according to the follow-up period. Diminished LA function was the only predictor of recurrence in the 2-year follow-up. Pre-procedural assessment of LA function might be helpful in selecting those patients who would benefit from RFCA. (Int Heart J 2014; 55: 312-318) Key words: Atrial fibrillation recurrence, Left atrial function, Radiofrequency catheter ablation, Echocardiographic predictors R adiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has evolved as an effective therapeutic option in the last decade. RFCA is considered to be a potentially curative treatment to restore sinus rhythm (SR) by eliminating the focus of arrhythmia and modifying the left atrial (LA) structural substrate of AF. However, the recurrence rate after RFCA remains unsatisfactory (15% to ≥ 50%) depending on the ablation strategy and the type of AF.1,2) RFCA is an expensive procedure with potentially critical complications. 3)Thus, it is crucial to identify those patients who are most likely to benefit from AF ablation with respect to restoration of the SR. Several clinical parameters, biomarkers, and imaging parameters have been reported to predict AF recurrence after RFCA. The reported predictors of recurrence after ablation are the presence of hypertension, long duration of AF, prolonged procedural time, enlarged LA diameter (LAD), or increased LA volume (LAV) and decreased LA function. [4][5][6][7][8][9] However, there is no consensus regarding the risk factors for recurrence because of heterogeneities in the study population, differences in the follow-up period, and differences in the type of AF.Echocardiography has a well-recognized and essential role in the current guidelines for the assessment of cardiac structure and function in patients with AF.10) Several echocardiographic parameters for predicting th...

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“…11,12 Indexed LA volume (LAV) was shown to be strongly associated with AF recurrence after catheter ablation in a cohort of patients with paroxysmal and persistent AF. 13,14 Among the tissue Doppler imaging (TDI) parameters, the E/E' is the key parameter in the estimation of the degree of diastolic dysfunction and this parameter was evaluated for AF recurrence after electrical cardioversion 15 and catheter ablation. 11 Based on these results, there is no single echo parameter which can be able to clearly predict AF occurrence and identify patients who will benefit from catheter ablation.…”

Section: Introductionmentioning

confidence: 99%

Atrial remodeling and subsequent atrial tachyarrhythmias

Kohári

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Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation

Cited by 39 publications

References 27 publications

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The Difference of Predictors for Recurrence After Catheter Ablation of Non-Paroxysmal Atrial Fibrillation According to Follow-Up Period

Atrial remodeling and subsequent atrial tachyarrhythmias

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