Matthias Bossard1,2,3,4, Sven Knecht1,2, Stefanie Aeschbacher1,2, Ronny R Buechel5, Thomas Hochgruber2,6, Andreas J Zimmermann2,6, Arnheid Kessel-Schaefer1,2, Frank-Peter Stephan1,2, Gian Völlmin1,2, Maurice Pradella7, Christian Sticherling1,2, Stefan Osswald1,2, Beat A Kaufmann1,2, David Conen1,2,4,6, Michael Kühne1,2. 1. Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland. 2. Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. 3. Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada. 4. Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada. 5. Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. 6. Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland. 7. Department of Radiology and Nuclear Medicine, University Hospital Basel, University Basel, Basel, Switzerland.
Abstract
BACKGROUND: Arrhythmia 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 RESULTS: Consecutive 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/m2 , 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. CONCLUSION: Our 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.
BACKGROUND:Arrhythmia 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 RESULTS: Consecutive 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/m2 , 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. CONCLUSION: Our 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.
Authors: Philipp Krisai; Stefanie Aeschbacher; Matthias Bossard; Elena Herber; Steffen Blum; Pascal Meyre; Thilo Burkard; Michael Kühne; Stefan Osswald; Beat A Kaufmann; David Conen Journal: Cardiol Res Pract Date: 2020-04-17 Impact factor: 1.866