Does larger pulmonary vein size measured by cardiovascular magnetic resonance predict atrial fibrillation recurrence after pulmonary vein isolation?
Larger pulmonary vein size measured by cardiovascular magnetic resonance prior to ablation is independently associated with late recurrent atrial fibrillation after pulmonary vein isolation.
BACKGROUND: The relationship between pulmonary vein (PV) anatomy and successful catheter ablation of atrial fibrillation (AF) is poorly understood METHODS: First-pass contrast enhanced PV magnetic resonance angiography was performed in 71 consecutive patients prior to PV isolation. PV diameter and cross-sectional area (CSA) were measured prior to PV isolation. Any symptomatic or asymptomatic AF >10s was considered a recurrence. Early recurrence was defined as recurrent AF ≤30 days after PV isolation, while late recurrence of AF was defined as recurrent AF >30 days after. RESULTS: At 1 year, 57% had any recurrence of AF while 41% had late recurrence of AF. Study subjects with one or more PV diameter in the top 10(th) percentile had trend toward more early recurrent AF (HR 1.99, p = 0.053). Study subjects with one or more PV CSA in the top 10th percentile had more late recurrent AF (HR 2.25, p = 0.039) and a trend toward more early recurrent AF (HR 1.94, p = 0.064). With multivariate analysis, PV size was not associated with early recurrent AF, but late recurrent AF was associated with one or more large PV, increased left atrial size, and non-paroxysmal AF. Study subjects with all three of these risk factors had a 100% rate of late recurrent AF at 1 year, while those with none had a 7% rate of late recurrent AF. CONCLUSIONS: Larger PV size is independently associated with more late recurrent AF after PV isolation. Determination of PV size prior to PV isolation may predict procedural success.
Hauser et al. (2015) studied this question.