What is the clinical evidence from this study?

Study design: Cohort. Population: Nonvalvular Atrial Fibrillation (n=63). Intervention: Right atrial anatomical remodeling (RAVI). Primary outcome: Early recurrence (<3 months) of atrial fibrillation (OR 1.650, 95% CI 1.017-2.677, p=0.04).

January 1, 2012Circulation JournalOpen Access

Right Atrial Anatomical Remodeling Affects Early Outcomes of Nonvalvular Atrial Fibrillation After Radiofrequency Ablation

Q: What are the key findings of this study?

Right atrial volume index was an independent predictor of early atrial fibrillation recurrence after radiofrequency ablation (OR 1.650 per 10 ml/m² increase; 95% CI 1.017-2.677; P=0.04).

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Key result

Right atrial volume index was an independent predictor of early atrial fibrillation recurrence after radiofrequency ablation (OR 1.650 per 10 ml/m² increase; 95% CI 1.017-2.677; P=0.04).

Why the study?

Does right atrial anatomical remodeling predict early and 1-year recurrence of atrial fibrillation after radiofrequency ablation in patients with nonvalvular atrial fibrillation?

Study Design

Type

Cohort (n=63)

Structured PICO

Does right atrial anatomical remodeling predict early and 1-year recurrence of atrial fibrillation after radiofrequency ablation in patients with nonvalvular atrial fibrillation?

Population

63 patients (50 men, mean age 57±10 years) with nonvalvular atrial fibrillation (23 persistent, 40 paroxysmal) who underwent radiofrequency ablation at a single center in Seoul, Korea. Excluded: history of lung disease (e.g., COPD) or organic heart disease (significant tricuspid regurgitation, >moderate pulmonary hypertension, or right ventricular cardiomyopathy).

Intervention

Radiofrequency ablation (circumferential pulmonary vein isolation using a 3.5-mm irrigated-tip catheter, with linear ablation and complex fragmented atrial electrogram ablation if needed, plus cavotricuspid isthmus ablation in all patients).

Outcome

Early recurrence of atrial fibrillation (within 3 months) and 1-year recurrence of atrial fibrillation after successful radiofrequency ablation.hard clinical

Main Result

Effect estimate: OR 1.650 (95% CI 1.017-2.677)

p-value: p=0.04

Limitations

Small sample size
Highly selected patients for RFA (patients with severe LA enlargement were excluded)
Echocardiographic measurement of LA volume has inborn limitations in patients with severely abnormal LA
Electrophysiological parameters were measured after sedation and cannot be considered baseline measurements
Lack of 1- or 2-year follow-up MDCT data to evaluate probable reverse remodeling of RA after AF ablation

Implication

May refine pre-ablation risk stratification for early AF recurrence; hypothesis-generating and requires prospective validation.

Abstract

BACKGROUND: The impact of the right atrial (RA) anatomical remodeling on outcomes of atrial fibrillation (AF) after radiofrequency ablation (RFA) is unclear. METHODS AND RESULTS: Sixty-three patients (50 men, 57±10 years, 23 persistent AF [PeAF]) who underwent RFA for AF were enrolled. Both RA and left atrial (LA) volumes, measured with multidetector computed tomography, as well as echocardiographic parameters were compared between subjects with early (<3 months, n=13) or 1-year (n=19) recurrence after RFA and without recurrence. The RA volume index (RAVI) was larger (98±21 vs. 77±22 ml/m²) and PeAF was more common (62% vs. 30%) in the early recurrence group (P<0.05 for all), whereas the LA volume index (LAVI) was similar between the 2 groups (78±15 vs. 72±19 ml/m², P=0.23). Notably, RAVI was the only independent predictor of early recurrence (for each 10 ml/m² increase, OR: 1.650, 95%CI: 1.017-2.677, P=0.04). PeAF was the only independent predictor of 1-year recurrence after RFA (OR: 4.496, 95%CI: 1.110-18.211, P=0.04), whereas RAVI and LAVI were not. CONCLUSIONS: RA anatomical remodeling might affect the early recurrence of AF after RFA. However, the chronicity of AF, rather than RA and LA anatomical remodeling, is a determinant of 1-year recurrence of AF after RFA.

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Cite This Study

Moon et al. (2012) conducted a cohort in Nonvalvular Atrial Fibrillation (n=63). Right atrial anatomical remodeling (RAVI) was evaluated on Early recurrence (<3 months) of atrial fibrillation (OR 1.650, 95% CI 1.017-2.677, p=0.04). Right atrial volume index was an independent predictor of early atrial fibrillation recurrence after radiofrequency ablation (OR 1.650 per 10 ml/m² increase; 95% CI 1.017-2.677; P=0.04).

synapsesocial.com/papers/6a11dce75a604c357c21b162 https://doi.org/10.1253/circj.cj-11-1232