Background:
Left atrial volume (LAV) and low voltage areas (LVA) are markers for impaired outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients.
Hypothesis:
to investigate association between the LAV/RAV ratio and LVA presence.
Methods:
Patients undergoing first AF ablation with pre-procedural cardiovascular magnetic resonance (CMR) imaging were included. LVA were assessed peri-procedurally using high-density 3D maps and defined as <0.5 mV. LAV was determined using a biplane model based on cine 4- and 2-chamber views, RAV using a monoplane model based on the cine 4-chamber view. Both volumes were indexed to body surface areas, and the LAV/RAV ratio was calculated. LAV/RAV ratio >1 indicated isolated LA dilatation, ratio ≤1 was defined as biatrial/isolated RA dilatation.
Results:
The study population included 184 patients (Age 63±10 years, 34% women, 58% persistent AF, 22% LVA). There were 148 (80%) patients with isolated LA dilatation. In univariable analysis, isolated LA dilatation was associated with LVAs (OR 6.803, 95% CI 1.395-26.514, p=0.016). This association remained robust in multivariable model after adjustment for persistent AF, CHA
2
DS
2
-VASc score, renal function, and heart rate (OR 5.981, 95%CI 1.256-28.484, p=0.025). Using ROC analysis, LAV/RAV ratio (AUC 0.668, 95% CI 0.585-0.751, p<0.001, Figure) was significant predictor for LVA. Biatrial/isolated RA dilatation occurred in 36 (20%) patients. On multivariable analysis, after adjustment for age, persistent AF, and renal function, male sex remained significantly associated with biatrial/isolated RA dilatation (OR 3.040, 95% CI 1.050-8.802, p=0.040).
Conclusions:
LAV/RAV ratio is useful for the prediction of LVA in AF. Isolated LA dilatation was associated with LVA presence, while male sex remained associated with biatrial/isolated RA dilatation and less LVA.
PREDICTION OF ATRIAL FIBRILLATION RECURRENCE AT SIX MONTHS POST DIRECT CURRENT CARDIOVERSION: RIGHT ATRIAL VOLUME, LEFT ATRIAL VOLUME OR BOTH?
