What does this research mean for the field?

An abutting left atrial appendage and left superior pulmonary vein independently predicts a higher risk of atrial fibrillation recurrence after point-by-point catheter ablation for paroxysmal AF. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to determine if the proximity of the left atrial appendage and left superior pulmonary vein is linked to atrial fibrillation recurrence following catheter ablation.

February 15, 2022Frontiers in Cardiovascular MedicineOpen Access

Abutting Left Atrial Appendage and Left Superior Pulmonary Vein Predicts Recurrence of Atrial Fibrillation After Point-by-Point Pulmonary Vein Isolation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Paroxysmal atrial fibrillation (n=428). Intervention: Abutting left atrial appendage and left superior pulmonary vein vs. Non-abutting left atrial appendage and left superior pulmonary vein. Primary outcome: Atrial fibrillation recurrence (HR 1.55, 95% CI 1.04-2.31, p=0.030).

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Key result

An abutting left atrial appendage and left superior pulmonary vein independently predicted a higher risk of atrial fibrillation recurrence after catheter ablation (adjusted HR 1.55).

Why the study?

The role of the spatial relationship between the left superior pulmonary vein and left atrial appendage in AF recurrence after catheter ablation for paroxysmal AF is unknown.

Does an abutting left atrial appendage and left superior pulmonary vein predict atrial fibrillation recurrence after point-by-point pulmonary vein isolation in patients with paroxysmal AF?

Population

428 consecutive patients undergoing initial point-by-point radiofrequency catheter ablation for paroxysmal AF

Comparison

Abutting LAA-LSPV (distance < 2 mm) vs non-abutting anatomy

Design

Single-center observational cohort study

Authors

NSNándor SzegediElectrophysiology JSJudit SimonMassachusetts General Hospital BSBálint SzilveszterSemmelweis University

Discussion

Member takes

Implication

May flag higher AF recurrence risk on pre-procedural CT; hypothesis-generating for anatomy-guided ablation trials.

Key Points

The study aims to determine if the proximity of the left atrial appendage and left superior pulmonary vein is linked to atrial fibrillation recurrence following catheter ablation.
Inclusion of 428 patients who underwent radiofrequency ablation for paroxysmal AF between 2014-2017 at Semmelweis University.
Pre-procedural cardiac CT was performed to assess left atrial and pulmonary vein anatomy, defining abutting as <2mm distance.
Univariable and multivariable analyses were conducted to identify predictors of AF recurrence.
AF recurrence rate was 33.4%, with a median recurrence-free time of 21.2 months (8.8–43.0).
Abutting left atrial appendage and left superior pulmonary vein increased the risk of AF recurrence (HR = 1.55; 95% CI = 1.04–2.31; p = 0.030).
Other factors associated with recurrence included female sex, LAA flow velocity, and LAA orifice area.

Study Design

Type

Cohort (n=428)

Multicenter

Structured PICO

Does an abutting left atrial appendage and left superior pulmonary vein predict atrial fibrillation recurrence after point-by-point pulmonary vein isolation in patients with paroxysmal AF?

Population

428 patients with paroxysmal atrial fibrillation undergoing initial point-by-point radiofrequency catheter ablation, followed for a median of 21.2 months.

Exposure

Presence of abutting left atrial appendage and left superior pulmonary vein (LAA-LSPV), defined as minimum distance < 2 mm on pre-procedural cardiac CT.

Comparator

Absence of abutting LAA-LSPV (minimum distance ≥ 2 mm).

Outcome

Atrial fibrillation recurrence.hard clinical

Main Result

Hazard Ratio: 1.55 (95% CI 1.04–2.31)

p-value: p=0.030

An abutting left atrial appendage and left superior pulmonary vein (distance < 2 mm) on pre-procedural CT independently predicts AF recurrence after point-by-point radiofrequency catheter ablation for paroxysmal AF.

Limitations

Single-center retrospective study design
Potential ability to capture the LAA from non-ostial LSPV segments was not investigated
Ablations were guided by force-time integral rather than newer techniques like high power ablation or CLOSE-protocol
Potential missed short AF episodes during follow-up due to lack of transtelephonic ECG devices

Cite This Study

Szegedi et al. (2022) conducted a cohort in Paroxysmal atrial fibrillation (n=428). Abutting left atrial appendage and left superior pulmonary vein vs. Non-abutting left atrial appendage and left superior pulmonary vein was evaluated on Atrial fibrillation recurrence (HR 1.55, 95% CI 1.04-2.31, p=0.030). An abutting left atrial appendage and left superior pulmonary vein independently predicted a higher risk of atrial fibrillation recurrence after catheter ablation (adjusted HR 1.55).

synapsesocial.com/papers/6a6da1c1ac440176ef2733bf https://doi.org/10.3389/fcvm.2022.708298

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Abutting Left Atrial Appendage and Left Superior Pulmonary Vein Predicts Recurrence of Atrial Fibrillation After Point-by-Point Pulmonary Vein Isolation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Abutting Left Atrial Appendage and Left Superior Pulmonary Vein Predicts Recurrence of Atrial Fibrillation After Point-by-Point Pulmonary Vein Isolation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

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