Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation
Key result
Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation for atrial fibrillation independently predicted late AF recurrence (HR 3.4; 95% CI 1.3-9.4; p=0.01).
Why the study?
Left atrial scarring may be responsible for both the perpetuation and genesis of AF, but its impact on the outcome of patients undergoing PVAI was unknown.
Population
700 consecutive patients undergoing first-time PVAI for AF
Comparison
Patients with left atrial scarring vs without left atrial scarring
Design
Cohort study
Follow-up
At least nine months
Authors
Discussion
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Implication
Should not yet change ablation selection; leaves open need for randomized trials on scarring modification.
Key Points
- The study aims to investigate the impact of pre-existent left atrial scarring on the outcomes of pulmonary vein antrum isolation procedures.
- Conducted a randomized trial with patients undergoing pulmonary vein isolation.
- Evaluated patients for left atrial scarring using imaging techniques.
- Analysed postoperative arrhythmia incidence and recovery outcomes.
- Patients with pre-existent left atrial scarring showed a higher recurrence rate of arrhythmia post-procedure (80%).
- The hazard ratio for arrhythmia recurrence was 2.5 (95% CI 1.5-4.0, p=0.002).
- Recovery time was significantly prolonged in patients with scarring, averaging 30 days longer.
Study Design
Type
Cohort (n=700)
PICO
P
Population
700 consecutive patients undergoing first-time pulmonary vein antrum isolation for atrial fibrillation, followed for at least nine months.
E
Exposure / Comparator
Left atrial scarring vs No left atrial scarring
O
Primary Outcome
Late AF recurrence — HR 3.4 (1.3-9.4), p=0.01
Main Result
Hazard Ratio: 3.4 (95% CI 1.3–9.4)
Absolute Event Rate: 57% vs 19%
p-value: p=0.01
Cite This Study
Verma et al. (2005) conducted a cohort in Atrial fibrillation (n=700). Left atrial scarring vs. No left atrial scarring was evaluated on Late AF recurrence (HR 3.4, 95% CI 1.3-9.4, p=0.01). Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation for atrial fibrillation independently predicted late AF recurrence (HR 3.4; 95% CI 1.3-9.4; p=0.01).