Why the study?
Catheter ablation remains associated with a high recurrence rate of AF, prompting investigation into LA structure and function indices that predict recurrence.
Do left atrial structure and function indices predict recurrence of atrial fibrillation after catheter ablation?
Do left atrial structure and function indices predict recurrence of atrial fibrillation after catheter ablation?
Echocardiographic indices of left atrial structure and function, specifically LA strain <19%, LA diameter ≥50 mm, and LA volume >150 ml, are strong predictors of atrial fibrillation recurrence following catheter ablation.
May refine pre-ablation AF recurrence risk stratification; supports routine LA assessment while leaving prospective outcome impact open.
BACKGROUND: Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF. METHODS: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included. RESULTS: The pooled analysis showed that after a follow-up period of 21 ± 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2·99 ([95% CI 2·50-3·47], P<0·001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0·0001 for both), larger LA area (P<0·0001), lower LA strain (P<0·0001) and lower LA total emptying fraction (LA EF) (P<0·0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3·1[95% CI, -1.3-10·4], P<0·0001), followed by LA diameter ≥50 mm (OR: 2·75, [95% CI 1·66-4·56,] P<0·0001), and LAVmax >150 ml (OR: 2·25, [95% CI, 1.1-5·6], P = 0·0002). CONCLUSIONS: Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
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Bajraktari et al. (2019) studied this question.
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