March 29, 2016PLoS ONEOpen Access

Multivariate Analysis of Correspondence between Left Atrial Volumes Assessed by Echocardiography and 3-Dimensional Electroanatomic Mapping in Patients with Atrial Fibrillation

Q: What are the key findings of this study?

2D-echocardiographic assessment using the prolate-ellipsoid method significantly underestimated true left atrial volume by an average of 64 ml compared to 3D-electroanatomic mapping.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Fibrillation (n=535). Intervention: 2D-echocardiography (LAVEllipsoid) vs. 3D-electroanatomic mapping (LAVCARTO). Primary outcome: Left atrial volume assessment (Bias -64 ml, 95% CI -132 to 2, p=<0.0001).

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Key result

2D-echo underestimates true left atrial volume by ~64 ml versus 3D-electroanatomic mapping.

Bias -64 ml
95% CI -132 to 2
P<0.0001
n=535

Why the study?

Does multivariate adjustment using clinical characteristics improve the agreement between 2D-echocardiographic left atrial volume indices and 3D-electroanatomic mapping in patients with atrial fibrillation?

Population

535 patients with non-valvular atrial fibrillation undergoing catheter ablation at three specialized…

Comparison

2D-echocardiographic indices of left atrial… vs Left atrial volume derived from…

Design

Cohort

Authors

ŠHŠtěpán HavránekElectrophysiology MFMartin FialaSemmelweis University ABAlan BulavaElectrophysiology

Discussion

Member takes

Implication

Clinicians should interpret 2D echo LA volumes cautiously in AF; this observational analysis leaves open whether clinical adjustment narrows bias versus 3D mapping.

Study Design

Type

Observational (n=535)

Multicenter

Yes

Structured PICO

Population

535 patients with non-valvular atrial fibrillation (43% paroxysmal) undergoing catheter ablation at three specialized centers, mean age 59 ± 9 years, 67% male.

Intervention

2D-echocardiographic indices of left atrial volume (LAD3, LAVEllipsoid, LAVPlanimetry) with and without multivariate adjustment for clinical characteristics

Comparator

Left atrial volume derived from 3D-electroanatomic mapping (LAVCARTO)

Outcome

Agreement and correlation between 2D-echocardiographic indices of left atrial size and left atrial volume derived from 3D-electroanatomic mappingsurrogate

Main Result

Effect estimate: Bias -64 ml (95% CI -132 to 2)

Absolute Event Rate: 72% vs 137%

p-value: p=<0.0001

Standard 2D echocardiography significantly underestimates true left atrial volume in patients with atrial fibrillation, but accuracy can be improved by adjusting for clinical factors like age, gender, AF type, and structural heart disease.

Limitations

The study was not prospectively designed and data collection was not independently monitored.
Centers did not contribute equally to the total study population, leading to some imbalance in patient characteristics.
Biplane-disc methods were not used, precluding analysis of potential benefits over single-plane assessment.
Proposed equations for adjustment of ECHO-based LAV were not validated in an independent population.
Results may not translate to the general population of cardiac patients or to patients with valvular AF.
Not prospectively designed and data collection not independently monitored
Centers did not contribute equally to the total study population and some imbalance in patient characteristics among centers
Biplane-disc methods were not used
Proposed equations for adjustment of ECHO-based LAV were not validated in an independent population
Results cannot be translated to general population of cardiac patients or patients with valvular AF

Cite This Study

Havránek et al. (2016) conducted an observational in Atrial Fibrillation (n=535). 2D-echocardiography (LAVEllipsoid) vs. 3D-electroanatomic mapping (LAVCARTO) was evaluated on Left atrial volume assessment (Bias -64 ml, 95% CI -132 to 2, p=<0.0001). 2D-echocardiographic assessment using the prolate-ellipsoid method significantly underestimated true left atrial volume by an average of 64 ml compared to 3D-electroanatomic mapping.

synapsesocial.com/papers/6a0d07c64e02b7512ccc94bd https://doi.org/10.1371/journal.pone.0152553

Topics

Echocardiography Atrial fibrillation Persistent AF management AF ablation outcomes

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Implication

Clinicians should interpret 2D echo LA volumes cautiously in AF; this observational analysis leaves open whether clinical adjustment narrows bias versus 3D mapping.

Multivariate Analysis of Correspondence between Left Atrial Volumes Assessed by Echocardiography and 3-Dimensional Electroanatomic Mapping in Patients with Atrial Fibrillation

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Multivariate Analysis of Correspondence between Left Atrial Volumes Assessed by Echocardiography and 3-Dimensional Electroanatomic Mapping in Patients with Atrial Fibrillation

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider