Journal
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
Volume 28, Issue 6, Pages 651-658Publisher
WILEY
DOI: 10.1111/jce.13202
Keywords
atrial fibrillation; catheter ablation; echocardiography; left atrium; outcome; pulmonary vein isolation; recurrence
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Funding
- Mach Gaensslen Foundation
- University Hospital Basel
- University of Basel
- Freie Akademische Gesellschaft (FAG) Basel
- Swiss National Science Foundation [PP00P3_159322, 3232B0_141603, 310030_149718]
- Swiss National Science Foundation (SNF) [310030_149718, 3232B0-141603] Funding Source: Swiss National Science Foundation (SNF)
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Echocardiography to Predict AF Recurrence BackgroundArrhythmia recurrence after atrial fibrillation (AF) ablation remains high and requires repeat interventions in a substantial number of patients. We assessed the value of conventional and 3-D echocardiography to predict AF recurrence. Methods and ResultsConsecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Echocardiograms were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including 3-D left atrial (LA) volumetry and determination of LA function and sphericity. The primary endpoint, AF recurrence (>30 seconds) between 3 to 12 months after AF ablation, was independently adjudicated. We included 276 patients (73% male, mean age 59.9 9.9 years). Paroxysmal and persistent AF were present in 178 (64%) and 98 (36%) patients, respectively. Mean left ventricular ejection fraction and indexed LA volume in 3-D (LAVI) were 52 +/- 12% and 42 +/- 13 mL/m(2), respectively. AF recurrence was observed in 110 (40%) patients after a single procedure. Median (interquartile range) time to AF recurrence was 123 (92; 236) days. In multivariable Cox regression models, the only predictors for AF recurrence were the minimal, maximal, and indexed 3-D LA volumes, P = 0.024, P = 0.016, and P = 0.014, respectively. Quartile specific analysis of 3-D LAVI showed an HR of 1.885 (95%CI 1.066-3.334; P for trend = 0.015) for the highest compared to the lowest quartile. ConclusionOur results show the important role of LA volume for the long-term freedom from arrhythmia after AF ablation. These data also highlight the potential of 3-D echocardiography in this context and may facilitate patient selection for AF ablation.
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