Key result
In patients with long-standing persistent atrial fibrillation, 2D echocardiography significantly underestimated left atrial volume by an absolute bias of 85 ml compared to electroanatomic mapping.
Why the study?
Does 2D echocardiography accurately measure left and right atrial volumes compared to electroanatomic mapping in patients with long-standing persistent atrial fibrillation?
Observational (n=173)
Yes
Does 2D echocardiography accurately measure left and right atrial volumes compared to electroanatomic mapping in patients with long-standing persistent atrial fibrillation?
Effect estimate: Absolute bias -85 ml (95% CI -148 to -22)
Absolute Event Rate: 92% vs 178%
p-value: p=<0.000001
In patients with long-standing persistent atrial fibrillation, 2D echocardiography significantly underestimates both left and right atrial volumes compared to electroanatomic mapping, suggesting caution when using 2D echo for patient selection.
May support caution with 2D echo atrial volumes in persistent AF; leaves open mapping's role in candidate selection.
Left atrial (LA) volume (LAV) is used for the selection of patients with atrial fibrillation (AF) to rhythm control strategies. Calculation of LAV from the LA diameters and areas by two-dimensional (2D) echocardiography may result in significant error. Accuracy of atrial volume assessment has never been studied in patients with long-standing persistent AF (LSPAF) and significant atrial remodeling. This study investigated correlation and agreement between 2D echocardiographic (Simpson method) and electroanatomic (CARTO, Biosense Webster) left and right atrial (RA) volumes (LAV(ECHO) vs. LAV(CARTO) and RAV(ECHO) vs. RAV(CARTO)) in patients undergoing catheter ablation for LSPAF. The study enrolled 173 consecutive subjects (females: 21 %, age: 59+/-9 years). There was only modest correlation between LAV(ECHO) (92+/-31 ml) and LAV(CARTO) (178+/-37 ml) (R=0.57), and RAV(ECHO) (71+/-29 ml) and RAV(CARTO) (173+/-34 ml) (R=0.42), respectively. LAV(ECHO) and RAV(ECHO) underestimated LAV(CARTO) and RAV(CARTO) with the absolute bias (+/-1.96 standard deviation) of -85 (-148; -22) ml and -102 (-169; -35) ml, respectively, and with the relative bias of -48 (-75; -21) % and -59 (-88; -30) %, respectively (all P<0.000001 for their mutual difference). Significant confounders of this difference were not identified. In patients with LSPAF, 2D echocardiography significantly underestimated both LA and RA volumes as compared with electroanatomic reference. This disagreement was independent of clinical, echocardiographic and mapping characteristics.
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Škňouřil et al. (2017) conducted an observational in Long-standing persistent atrial fibrillation (LSPAF) (n=173). 2D echocardiography (Simpson method) vs. Electroanatomic mapping (CARTO) was evaluated on Left atrial volume (LAV) (Absolute bias -85 ml, 95% CI -148 to -22, p=<0.000001). In patients with long-standing persistent atrial fibrillation, 2D echocardiography significantly underestimated left atrial volume by an absolute bias of 85 ml compared to electroanatomic mapping.
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