What is the clinical evidence from this study?

Study design: Cohort. Population: Nonvalvular Atrial Fibrillation (n=111). Intervention: Radiofrequency catheter ablation (RFCA). Primary outcome: 1-year recurrence of atrial fibrillation (associated with each 10 mL/m2 increase in Left Atrial Volume Index) (OR 1.36, 95% CI 1.08-1.71, p=0.009).

January 1, 2015Open Access

Prognostic Implications of Right and Left Atrial Enlargement after Radiofrequency Catheter Ablation in Patients with Nonvalvular Atrial Fibrillation

Key Result

Right atrial enlargement independently predicted early recurrence of atrial fibrillation after catheter ablation (OR 1.31), while left atrial enlargement independently predicted 1-year recurrence (OR 1.36).

Study Design

Type

Cohort (n=111)

Multicenter

Structured PICO

Does right and left atrial enlargement predict recurrence of atrial fibrillation after radiofrequency catheter ablation in patients with nonvalvular AF?

Population

111 patients with nonvalvular atrial fibrillation (87 men; mean age, 57±11 years; 68 with paroxysmal AF) who underwent radiofrequency catheter ablation, excluding those with cardiomyopathy, pericardial disease, moderate or greater valvular heart disease, congenital cardiac abnormality, or lung diseases.

Intervention

Radiofrequency catheter ablation (RFCA) with three-dimensional volume measurement of right and left atria using multi-detector computed tomography (MDCT)

Comparator

Patients with vs. without recurrence of atrial fibrillation

Outcome

Recurrence of atrial fibrillation (early <3 months, 6-month, and 1-year)hard clinical

Right atrial enlargement is more closely associated with early recurrence of atrial fibrillation after catheter ablation, whereas left atrial enlargement is a stronger predictor of long-term recurrence.

Main Result

Effect estimate: OR 1.36 (95% CI 1.08-1.71)

p-value: p=0.009

Limitations

Single tertiary center study, which may not be representative of all patients with atrial fibrillation.
Multi-detector computed tomography (MDCT) for measuring cardiac chamber size has not been widely validated.
No follow-up right atrial size measurement was performed to elucidate reverse right atrial remodeling.

Abstract

BACKGROUND AND OBJECTIVES: The prognostic role of the right atrium (RA) compared with that of the left atrium (LA) is unclear in patients with atrial fibrillation (AF). We assessed structural changes in both atria and determined their association with recurrence of AF after radiofrequency catheter ablation (RFCA). SUBJECTS AND METHODS: All 111 patients with nonvalvular AF (87 men; mean age, 57±11 years; 68 with paroxysmal AF) who underwent RFCA were enrolled consecutively. Three-dimensional volumes of both atria measured from computed tomography images were compared between subjects with and without recurrence of AF during the follow-up. RESULTS: Early (<3 months), 6-month, and 1-year recurrence was documented in 26 (24%), 30 (27%), and 36 (32%) patients, respectively. Significantly larger RA and LA volume indices (RAVI and LAVI) were observed in the early, 6-month, and 1-year recurrence groups (p<0.05 for all). In multivariate analysis, Early recurrence was independently associated with RAVI (for each 10 mL/m2 increase; odds ratio OR, 1.31; 95% confidence interval CI, 1.03-1.66, p= 0.03), but not with LAVI. However, both RAVI and LAVI failed to predict 6-month outcomes independently. LAVI was the only independent predictor of 1-year recurrence (for each 10 mL/m2 increase; OR, 1.36; 95% CI, 1.08-1.71, p=0.009). CONCLUSION: RA enlargement was more closely related to early recurrence of AF after RFCA than LA size. However, LA size, rather than RA volume, was a determinant of long-term AF prognosis after RFCA. These findings suggest a temporal pattern in the prognostic implication of enlargement in each atrium that switches over time after RFCA for AF.

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