Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation
Introduction
Catheter ablation has become an established treatment for patients with drug-refractory symptomatic atrial fibrillation (AF) [1], [2]. Despite high early success rates, late recurrence of AF after an ablation procedure is common [3]. Identifying the predictors of long-term success is therefore essential to select the patients who are most likely to benefit and avoid the unnecessary risks and costs of ineffective procedures. The type of AF (paroxysmal vs. non-paroxysmal) is one of the most consistently reported predictors of outcome after pulmonary vein isolation (PVI), and is the sole prognostic factor that affects the level of recommendation for catheter ablation in the current guidelines, mainly due to efficacy concerns in patients with non-paroxysmal AF [1], [2], [4]. Despite being recognized as a predictor of recurrence, relatively little importance is given to left atrium (LA) size, compared to the type of AF. However, and while a dilated LA usually underlies nonparoxysmal AF, it is not uncommon to find patients with persistent AF and normal sized LA, or with paroxysmal AF and dilated LA. The efficacy of AF catheter ablation in these subgroups is not well established. The purpose of this study was to assess the relative importance of LA volume and type of AF as predictors of outcome after PVI.
Section snippets
Patient characteristics and study design
All consecutive patients with symptomatic drug-refractory AF undergoing percutaneous PVI in two Portuguese centers (Hospital Santa Cruz, Carnaxide, Portugal; and Hospital da Luz, Lisbon, Portugal) were included in a prospective registry. Patients were enrolled between June 2005 and December 2011 in the first center, and between June 2007 and November 2012 in the second (with the overlapping period accounting for 79% of included patients). For the purposes of the present study, 197 patients
Clinical and procedural characteristics
During the study period, 809 patients underwent 905 ablation procedures, 491 (54.3%) using magnetic navigation and the remainder using manual navigation.
Patient characteristics are presented in Table 1. The majority of patients (73.2%, n = 592) had paroxysmal AF. Compared to patients with paroxysmal AF, those with non-paroxysmal AF had higher body mass index, higher LA volumes, and were more likely to undergo more than one ablation procedure. They also tended to be older and have a higher
Discussion
The present study assessed the relative impact of the type of AF and LA volume on the long-term outcome of PVI. Its findings can be summarized as follows. First, even though patients with non-paroxysmal AF have larger left atriums, there is a sizeable overlap between the LA volumes of individuals with paroxysmal and non-paroxysmal AF undergoing PVI. Second, our results suggest that LA volume is the most important determinant of recurrence, outweighing the type of AF as prognostic factor.
To our
Conclusion
Left atrial volume seems to be more important than the type of atrial fibrillation in predicting the long-term success of pulmonary vein isolation.
Grant support
None.
Conflict of interest
The authors declare they do not have any conflicts of interest in this study.
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2022, American Journal of CardiologyCitation Excerpt :LA size is predictive of AF recurrence but is also influenced by, for example, left ventricular filling pressure and mitral valve disease. Nevertheless, LA size has been demonstrated to be a better predictor of AF recurrence postablation than AF type.23 LA function, assessed with speckle tracking strain echocardiography, has also been demonstrated to predict postablation AF.
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All authors take responsibility for all aspects of reliability and freedom from bias of the data presented and their discussed interpretation.