scholarly journals The impact of catheter ablation for patients with asymptomatic atrial fibrillation: subanalysis of kansai plus atrial fibrillation (kpaf) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Pak ◽  
A Kobori ◽  
S Shizuta ◽  
Y Sasaki ◽  
T Toyota ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Primary Endpoint ◽  
Hazard Analysis ◽  
Secondary Endpoint ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
The Impact

Abstract Background Catheter ablation (CA) of atrial fibrillation (AF) for symptomatic patients improves the quality of life and prognosis of patients with heart failure. However, the impact of CA for asymptomatic patients is still controversial. Purpose We aimed to investigate the clinical outcomes of CA of AF for asymptomatic patients compared to those for symptomatic patients. Methods A total of 5,013 patients from the Kansai Plus Atrial Fibrillation (KPAF) Registry who underwent CA were screened. The patients were divided into three groups by type of AF; paroxysmal (PAF), persistent (PEAF) and long standing (LSAF) and the patients in each type of AF were divided into two groups: asymptomatic and symptomatic. The primary endpoint was recurrent supraventricular tachyarrhythmias lasting for more than 30 seconds during follow-up 4 years after CA. The secondary endpoint was a composite of cardiovascular, cerebral, and gastrointestinal events during follow-up 4 years after CA. The incidence of complications related to CA between asymptomatic and symptomatic patients was also evaluated. Kaplan–Meier analysis was employed to estimate the primary and secondary endpoints. The statistical differences in primary and secondary endpoints between asymptomatic and symptomatic patients were evaluated using a log–rank test. The impact of symptom due to AF on the primary and secondary endpoint was evaluated using a Cox hazard analysis. The difference in incidence of complications between asymptomatic and symptomatic patients was evaluated using a chi–square test. Results In this study population, PAF was the most frequent at 64.4%, followed by PEAF (22.7%) and LSAF (13.0%). There were some significant differences in the baseline characteristics between asymptomatic and symptomatic patients in each type of AF. The proportion of male was significantly higher in asymptomatic patients than symptomatic patients in PAF (81.2% versus 67.2%, p<0.001) and PEAF (86.4% versus 74.3%, p<0.001). Left atrial diameter was larger in asymptomatic patients than symptomatic patients only in PAF (40±6mm versus 38±6mm, p<0.001). In all types of AF, there was no significant difference in primary endpoint between asymptomatic and symptomatic patients as follows: 37.5% versus 40.6% (p=0.6) in PAF, 45.2% versus 55.1% (p=0.09) in PEAF and 59.3% versus 63.6% (p=1.0) in LSAF. There was also no significant difference in secondary endpoint between asymptomatic and symptomatic patients: 7.1% versus 6.8% (p=0.7) in PAF, 5.4% versus 8.7% (p=0.3) in PEAF and 4.4% versus 5.1% (p=0.5) in LSAF. In a Cox hazard analysis, the symptom did not affect both of the primary and secondary endpoints in each type of AF. In regard to the incidence of complications related to CA, there was no significant difference between asymptomatic and symptomatic patients in each type of AF. Conclusion CA of AF for asymptomatic patients can be safe and can lead to equivalent outcomes as well as symptomatic patients. Funding Acknowledgement Type of funding source: None

scholarly journals Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Yong-Soo Baek ◽  
Oh-Seok Kwon ◽  
Byounghyun Lim ◽  
Song-Yi Yang ◽  
Je-Wook Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Catheter Ablation ◽  
Computational Modeling ◽  
Controlled Trial ◽  
Dominant Frequency ◽  
Complication Rates ◽  
Clinical Recurrence ◽  
Significant Difference

Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF.Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group.Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P < 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016].Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF.Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.

Abstract 5659: Regular Atrial Tachycardias After Ablation Of Complex Fractionated Atrial Electrograms (CFAE) For Atrial Fibrillation: Acute Incidence And Recurrence In Clinical Follow-up

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tilko Reents ◽  
Gabriele Hessling ◽  
Stephanie Fichtner ◽  
Jinjin Wu ◽  
Heidi L Estner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Successful Ablation ◽  
Atrial Electrograms ◽  
Initial Procedure ◽  
The Impact ◽  
External Cardioversion ◽  
Complex Fractionated Atrial Electrograms

Background: The catheter ablation of atrial fibrillation (AF) can be performed by ablation of complex fractionated atrial electrograms (CFAE). Endpoint of CFAE ablation is the regularisation or termination of AF. However, the impact of regular atrial tachycardia (AT) occurring during CFAE ablation on long term outcome has not been investigated. Thus, it is not clear whether these tachycardias should be acutely targeted for ablation. Methods: In 43 patients (31 male, age 62±9 years with paroxysmal (15 patients), persistent (25 patietns) or permanent AF (3 patients) organisation of AF to regular AT was achieved by ablation of CFAE. Mapping of AT with subsequent successful ablation was performed in 14/43 patients (33%), in the remaining 29/43 patients (67%) AT was terminated with external cardioversion or pace overdrive. After ablation procedure, patients were seen in our out-patient clinic with repetitive Holter ECG after 1, 3, and subsequently every 3 months and were intensively screened for the occurrence of regular AT. Results: In follow-up 22/43 patients (51%) developed sustained AT necessitating in 20 patients repeat catheter ablation (12 patients) or external cardioversion (8 patients). AF had been paroxysmal in 7/22 and persisten in 15/22 patients with AT in follow-up. In 14/22 patients (63%), no attempt for ablation of AT had been made during the initial procedure, in 8/22 AT (36%) had been mapped and initially successful ablated. Of 21 patients without AT occurrence during follow-up, AF had been paroxysmal in 8/21 and persistent or permanent in 13/21 patients. AT had been mapped and ablated in 6 (29%) whereas in 15/21 patients (71%), AT had not been targeted. Ablation of AT during initial procedure, number of ablation applications, procedure and fluoroscopy duration were not predictive for freedom of AT in follow-up. Conclusion: In our study, mapping and successful ablation of new onset regular atrial tachycardias (AT) occurring during ablation of CFAE for atrial fibrillation was not predictive for the occurrence of AT in follow-up. Thus, results after termination of AT by cardioversion was in long-term comparable to sometimes time-consuming mapping/ablation for AT.

scholarly journals Impact of Sinus Rhythm Maintenance on Major Adverse Cardiac and Cerebrovascular Events after Catheter Ablation of Atrial Fibrillation: Insights from AF Frontier Ablation Registry

2021 ◽  
Author(s):  
Keisuke Usuda ◽  
Takeshi Kato ◽  
Toyonobu Tsuda ◽  
Hayato Tada ◽  
Satoru Niwa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Af Ablation ◽  
Multicenter Cohort ◽  
Cerebrovascular Events ◽  
The Impact ◽  
Sinus Rhythm Maintenance

Introduction: The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. Methods and Results: We investigated 2737 consecutive patients (25.6% female, mean age 63.4 ± 10.3 years) who underwent a first catheter ablation for AF from the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 25.2 months, 2070 (75.6%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 122 (4.5%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.7 per 100 person-years) compared with the AF recurrence group (3.2 per 100 person-years; P = 0.001). The multivariate analysis revealed that freedom from AF (hazard ratio 0.57; 95% confidence interval 0.39–0.83; P = 0.003) was independently associated with the incidence of the composite event.¬¬ Conclusion: In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.

scholarly journals Evaluation of proarrythmogenic effects after different techniques of radiofrequency catheter ablation of atrial fibrillation

2015 ◽  
Vol 17 (1) ◽  
pp. 33 ◽  
Author(s):  
S. N. Artemenko ◽  
A. B. Romanov ◽  
V. V. Shabanov ◽  
I. G. Stenin ◽  
D. A. Yelesin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Linear Lesions ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

To assess proarrythmogenic effects after different techniques of radiofrequency catheter ablation, 427 patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation (AF) were examined. The patients were randomized into four groups: antral pulmonary vein isolation (PVI) (Group I), PVI plus roof line and mitral isthmus ablation (Group II), anatomic ablation of ganglionated plexuses (GP) of the left atrium (Group III) and GP plus PVI (Group IV). At the end of follow up (34,43,2 months) the largest number of proarrythmogenic effects was observed in Group II, 24,8% (26 patients). In the remaining groups the percentage of proarrythmogenic effects did not exceed 11%, neither was there any significant difference among Groups I, III and IV. Thus, the creation of additional linear lesions in the left atrium is a predictor of proarrythmogenic effects during follow up.

scholarly journals Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings from the CABANA Imaging Substudy

2021 ◽  
Author(s):  
Maryam E. Rettmann ◽  
David R. Holmes III ◽  
Kristi H. Monahan ◽  
Jerome F. Breen ◽  
Tristram D. Bahnson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Left Atrial ◽  
Volume Index ◽  
The Relationship ◽  
Af Recurrence

Background - The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial was a randomized, prospective trial of left atrial catheter ablation versus drug therapy for treatment of atrial fibrillation (AF). As part of CABANA, a prospective imaging sub-study was conducted. The main objectives were to describe the patterns of changes in the dimensions of the left atrium (LA) and pulmonary veins (PVs), and the relationship between these changes with treatment assignment and clinical outcomes. Methods - CT or MRI was acquired at baseline and follow-up in 121 ablation (median follow-up 101 days) and 85 drug patients (median follow-up 97 days). Left atrial volume index (LAVI), mean PV ostial diameter (MPV) , and ostial diameters of each PV separately were computed. We examined the relationship between the change from baseline to follow-up with subsequent clinical outcomes (composite of death, disabling stroke, serious bleeding, or cardiac arrest [CABANA primary endpoint], total mortality or cardiovascular hospitalization, first AF recurrence after the 90 day blanking period, first AF/atrial flutter/ atrial tachycardia after the 90 day blanking period) using Cox proportional-hazards models. Results - The median (25 th , 75 th ) change from baseline for LAVI was -7.8 mL/m 2 (-16.4, 0.2), ablation arm and -3.5 mL/m 2 (-11.4, 2.6), drug therapy arm. The LAVI decreased in 52.9% of ablation patients versus 40.0% of drug therapy patients. Change for MPV was -2.7 mm (-4.2, -1.3) in the ablation arm versus -0.1 mm (-1.5, 0.8) in the drug therapy arm. Changes in LA and PV dimensions had no consistent relationship with the risk of developing the study primary endpoint. Reductions in LAVI, and in MPV diameter were associated with decreased risk of AF recurrence. Conclusions - Ablation patients demonstrated more frequent and larger atrial structural changes compared with drug patients. These changes suggest a critical relationship between structural features and AF generation.

P6355The behavior of atrial fibrillation in patients with heart failure hospitalization

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Fukunaga ◽  
K Hirose ◽  
A Isotani ◽  
T Morinaga ◽  
K Ando
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Significant Difference ◽  
The Impact

Abstract Background Relationship between atrial fibrillation (AF) and heart failure (HF) is often compared with proverbial question of which came first, the chicken or the egg. Some patients showing AF at the HF admission result in restoration of sinus rhythm (SR) at discharge. It is not well elucidated that the restoration into SR during hospitalization can render the preventive effect for rehospitalization. Purpose To investigate the impact of restoration into SR during hospitalization for readmission rate of the HF patients showing AF. Methods We enrolled consecutive 640 HF patients hospitalized from January 2015 to December 2015. Patients data were retrospectively investigated from medical record. Patients showing atrial fibrillation on admission but unrecognized ever were defined as “incident AF”; patients with AF diagnosed before admission were defined as “prevalent AF”. Primary endpoint was a composite of death from cardiovascular disease or hospitalization for worsening heart failure. Secondary endpoints were death from cardiovascular disease, unplanned hospitalization related to heart failure, and any hospitalization. Results During mean follow up of 19 months, 139 patients (22%) were categorized as incident AF and 145 patients (23%) were categorized as prevalent AF. Among 239 patients showing AF on admission, 44 patients were discharged in SR (39 patients in incident AF and 5 patients in prevalent AF). Among incident AF patients, the primary composite end point occurred in significantly fewer in those who discharged in SR (19% vs. 42% at 1-year; 23% vs. 53% at 2-year follow-up, p=0.005). To compare the risk factors related to readmission due to HF with the cox proportional-hazards model, AF only during hospitalization [Hazard Ratio (HR)=0.37, p<0.01] and prevalent AF (HR=1.67, p=0.04) was significantly associated. There was no significant difference depending on LVEF. Conclusion Newly diagnosed AF with restoration to SR during hospitalization was a good marker to forecast future prognosis.

Abstract 256: Cardiac CT in Ablation of Atrial Fibrillation

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ala Mohsen ◽  
Nicole Worden ◽  
Manju Bengaluru Jayanna ◽  
Michael Giudici
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Cardiac Ct ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
Atrial Fibrillation Recurrence ◽  
Significant Difference ◽  
The Impact

Background: This study aims to determine the impact of pre-procedural cardiac computerized tomography (CT) on procedural efficacy, clinical outcome and complications in patients who undergo radiofrequency or cryo-therapy catheter ablation to eliminate atrial fibrillation (AF). Methods: In this retrospective review, Radiofrequency or Cryoballoon ablation was done on 50 consecutive patients with atrial fibrillation with mean age of 63 (Min 47-Max 86) with paroxysmal (8 2 %) or persistent (18%) AF. Twenty-five patients underwent cryoablation and twenty-five patients underwent Radiofrequency ablation to isolate the pulmonary veins. Procedural and clinical outcomes were compared among patients who underwent catheter ablation with and without pre procedural Cardiac CT. Results: Out of 50 consecutive patients between 01/2014 and 08/2014 there were 26 patients who had a pre-procedural CT scan and 24 patients who did not undergo a pre-procedural CT scan. The mean duration of the procedure (303 ± 93 vs. 271 ± 43 min, P = 0.244) and fluoroscopy time (53 ± 25 vs. 43 ± 17 min, P = 0.086) was similar among patients who did and did not have pre-procedural cardiac CT. The occurrence of complications such as bleeding, pericardial tamponade, pneumothorax, infection and embolic events were also similar in both groups. Repeat ablation was performed in 4 (15%) and 7 (29%) of the patients who did and did not have cardiac CT, respectively (P = 0.249). At 3 months, 5 (19%) and 2(8%) of the patients who did and did not have pre-procedural cardiac CT had atrial fibrillation recurrence (P =0.323). At 12 months, 6 (23%) and 4 (17%) of the patients who did and did not have pre-procedural cardiac CT had atrial fibrillation recurrence (P = 0.467). There was statistically significant difference in Radiation exposure (1805 [IQR 998-2397] vs. 1195 [IQR 738-1363] P=0.0323) between patients who did and did not get pre-procedural cardiac CT, which did not include the radiation added by performing the CT itself. Conclusions: Pre-procedural structural anatomy obtained by cardiac CT scan before catheter ablation for atrial fibrillation in a center where operators used both Radiofrequency and Cryoablation does not appear to have a significant effect on AF recurrence at 3 months or 1 year. The procedural radiation exposure was significantly less in the group that did not have pre-procedure cardiac CT.

scholarly journals Electrical posterior box isolation in persistent atrial fibrillation changed to paroxysmal atrial fibrillation: a multi-center, prospective, randomized study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.N Pak ◽  
J.B Park ◽  
H.T Yu ◽  
T.H Kim ◽  
J.S Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Recurrence Rate ◽  
Antiarrhythmic Drug ◽  
Persistent Atrial Fibrillation ◽  
Complication Rates ◽  
Clinical Recurrence ◽  
End Point ◽  
Significant Difference

Abstract Background Persistent atrial fibrillation (PeAF) can change to paroxysmal AF (PAF) after antiarrhythmic drug medication and cardioversion. Purpose We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient group. Methods We prospectively randomized 114 patients with PeAF to PAF (male 75%, 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). The primary end-point was AF recurrence after a single procedure, and the secondary end-point was a recurrence pattern, cardioversion rate, and the response to antiarrhythmic drugs (AADs). Results After a mean follow-up of 22.5±9.4 months, the clinical recurrence rate did not significantly differ between the two groups (29.8% vs. 28.1%, p=0.836; log rank p=0.815) The recurrence rate for atrial tachycardias (17.6% vs. 43.8%, p=0.141) was higher in POBI group, but the cardioversion rates (13.5% vs. 8.5%, p=0.434) were not significantly different between two groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% in CPVI group and 59.7% of POBI group (p=0.452). No significant difference was found in the major complication rates between the two groups (5.3% vs. 1.8%, p=0.618), but the total ablation time was significantly longer in the POBI group (4397±842 sec vs. 5337±1517 sec, p&lt;0.001). Conclusion In patients with persistent AF converted to paroxysmal AF by AAD, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation nor influence overall safety. Funding Acknowledgement Type of funding source: None

scholarly journals Electrical Posterior Box Isolation in Persistent Atrial Fibrillation Changed to Paroxysmal Atrial Fibrillation

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Hui-Nam Pak ◽  
Junbeom Park ◽  
Je-Wook Park ◽  
Song-Yi Yang ◽  
Hee Tae Yu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Antiarrhythmic Drug ◽  
Persistent Atrial Fibrillation ◽  
Complication Rates ◽  
Unique Identifier ◽  
Clinical Recurrence ◽  
Ablation Time ◽  
Significant Difference

Background: Persistent atrial fibrillation (AF) can change to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient groups. Methods: We prospectively randomized 114 patients with persistent AF to paroxysmal AF (men, 75%; 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). Primary end point was AF recurrence after a single procedure, and secondary end points were recurrence pattern, cardioversion rate, and response to antiarrhythmic drugs. Results: After a mean follow-up of 23.8±10.2 months, the clinical recurrence rate did not significantly differ between the CPVI alone and additional POBI group (31.6% versus 28.1%; P =0.682; log-rank P =0.729). The recurrences as atrial tachycardias (5.3% versus 12.3%; P =0.134) and cardioversion rates (5.3% versus 10.5%; P =0.250) were not significantly different between the CPVI and POBI groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% of CPVI group and 59.6% of POBI group ( P =0.450). No significant difference was found in major complication rates between the two groups (5.3% versus 1.8%; P =0.618), but the total ablation time was significantly longer in the POBI group (4187±952 versus 5337±1517 s; P <0.001). Conclusions: In patients with persistent AF converted to paroxysmal AF by antiarrhythmic drug, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation or influence overall safety, while leading to longer ablation time. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02176616.

scholarly journals Impact of Left Atrial Geometric Remodeling on Late Atrial Fibrillation Recurrence After Catheter Ablation

2021 ◽  
Author(s):  
Fuqian Guo ◽  
Caiying Li ◽  
Lan Yang ◽  
Chen Chen ◽  
Yicheng Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Volume Index ◽  
Multivariable Logistic Regression Analysis ◽  
Significant Difference ◽  
The Impact ◽  
Af Recurrence

Abstract Purpose: To quantitatively investigate the impact of left atrial (LA) geometric remodeling on atrial fibrillation (AF) recurrence after catheter ablation (CA).Methods: A retrospective analysis of 105 patients with AF who underwent coronary computed tomographic angiography before CA. Risk factors for AF recurrence were identified by multivariable logistic regression analysis and used to create a nomogram.Results: After at least 12 months of follow-up, 30 patients (29%) developed recurrent AF. Patients with recurrence had a higher LA volume, LA sphericity, and a lower LA ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that LA minimal volume index (LAVImin) (OR: 1.280, 95% CI: 1.027–1.594, P = 0.028), LA sphericity (OR: 1.268, 95% CI: 1.071–1.500, P = 0.006) and CHA2DS2-VASc score (OR: 1.326, 95% CI: 1.016–1.732, P=0.038) were independent predictors of AF recurrence. The combined model of the LA sphericity to the LAVImin substantially increased the predictive power for AF recurrence (area under the curve [AUC] = 0.736, 95% CI: 0.627–0.844, P < 0.001), with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.769 (95% CI: 0.666–0.872) and had good internal validity.Conclusion: The CHA2DS2-VASc score, LA sphericity, and LAVImin were significant and independent predictors of AF recurrence after CA. Furthermore, the nomogram had a better predictive capacity for AF recurrence.

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