A right to left atrial volume ratio (%RAVI/LAVI) <100.1 predicted higher 12-month arrhythmia-free survival compared to ≥100.1 (89.7% vs 45.2%, P<0.0001) after CPVI for longstanding persistent AF.
Observational (n=70)
Does the right to left atrial volume ratio (%RAVI/LAVI) predict arrhythmia recurrences after circumferential pulmonary vein isolation in patients with longstanding persistent atrial fibrillation?
The ratio of right to left atrial volume on pre-procedural CT is a strong predictor of arrhythmia recurrence after CPVI in longstanding persistent AF, helping to identify patients who may succeed with CPVI alone.
Effect estimate: HR 1.048
Absolute Event Rate: 89.7% vs 45.2%
p-value: p=<0.0001
BACKGROUND: We aimed to identify the predictors of clinical outcomes after circumferential pulmonary vein isolation (CPVI) without any substrate modification for longstanding persistent atrial fibrillation (LSP-AF). METHODS: This study retrospectively analyzed 70 consecutive LSP-AF patients who underwent an initial CPVI and were followed-up for more than 1 year. The right and left atrial volumes indexed to the body surface areas (right atrial volume index RAVI and left atrial volume index LAVI) were determined by preacquired contrast-enhanced computed tomography (CT). The %RAVI/LAVI was obtained as 100 × RAVI/LAVI. RESULTS: During a median follow-up period of 15 months (interquartile range, 13-19 months), 21 patients (30%) had arrhythmia recurrences after the CPVI. Antiarrhythmic drugs were continued in 34 patients (48%). In the Cox proportional hazard model, the %RAVI/LAVI was a significant positive predictor of arrhythmia recurrences (hazard ratio, 1.048; P = 0.039). A receiver-operating characteristic analysis demonstrated that at an optimal cutoff of 100.1 for the %RAVI/LAVI, the sensitivity and specificity for predicting arrhythmia recurrences were 85.7% and 71.4%, respectively. The Kaplan-Meier analysis showed that arrhythmia recurrences were less frequent in patients with a %RAVI/LAVI of <100.1 than in those with a %RAVI/LAVI of ≥100.1 (P < 0.0001), and the arrhythmia-free survival rate at 12 months was 89.7% and 45.2%, respectively. CONCLUSIONS: The ratio of the RAVI to LAVI on CT may be a useful predictor of clinical outcomes after CPVI of LSP-AF. LSP-AF patients with a less predominant right atrial enlargement relative to the left atrial enlargement may be good candidates for successful treatment with CPVI alone as the ablation strategy for LSP-AF.
Sasaki et al. (Mon,) conducted a observational in Longstanding persistent atrial fibrillation (LSP-AF) (n=70). %RAVI/LAVI <100.1 vs. %RAVI/LAVI ≥100.1 was evaluated on Arrhythmia recurrences (reported as arrhythmia-free survival at 12 months) (HR 1.048, p=<0.0001). A right to left atrial volume ratio (%RAVI/LAVI) <100.1 predicted higher 12-month arrhythmia-free survival compared to ≥100.1 (89.7% vs 45.2%, P<0.0001) after CPVI for longstanding persistent AF.