Combined assessment of left atrial volume parameters for predicting recurrence of atrial fibrillation following pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Fumitaka Soga; Hidekazu Tanaka; Yasuhide Mochizuki; Jun Mukai; Makiko Suto; Hiroki Takada; Yutaka Hatani; Hiroki Matsuzoe; Keiko Hatazawa; Hiroyuki Sano; Junichi Ooka; Hiroyuki Shimoura; Kensuke Matsumoto; Koji Fukuzawa; Ken–ichi Hirata

doi:10.1111/echo.14315

March 25, 2019EchocardiographyOpen Access

Combined assessment of left atrial volume parameters for predicting recurrence of atrial fibrillation following pulmonary vein isolation in patients with paroxysmal atrial fibrillation

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Why the study?

To determine whether comprehensive simplified left atrial assessment from routine echocardiography is more useful than assessment of left atrial volume alone for predicting AF recurrence after PVI.

Does comprehensive simplified left atrial assessment improve prediction of atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation?

Structured PICO

Does comprehensive simplified left atrial assessment improve prediction of atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation?

P

Population

156 patients with paroxysmal atrial fibrillation (PAF) who had undergone pulmonary vein isolation (PVI)

I

Intervention

Comprehensive simplified left atrial (LA) assessment (Max-LAVi, Min-LAVi, and ΔLAVi) derived from routine echocardiography performed within two days before PVI

C

Comparator

Assessment of LA volume alone (Max-LAVi ≥ 34 mL/m2) and clinical variables (age, gender, AF duration)

O

Outcome

Atrial fibrillation (AF) recurrence at 24 months follow-up

A comprehensive simplified left atrial assessment including ΔLAVi derived from routine echocardiography improves the prediction of atrial fibrillation recurrence after pulmonary vein isolation.

Implication

Simplified LA assessment may aid post-PVI AF recurrence prediction; leaves open whether it outperforms volume index alone in prospective studies.

Abstract

Objectives Our aim was to test the hypothesis that comprehensive simplified left atrial ( LA ) assessment derived from routine echocardiography may be more useful than assessment of LA volume alone for predicting atrial fibrillation ( AF ) recurrence after pulmonary vein isolation ( PVI ). Methods We studied 156 patients with paroxysmal AF ( PAF ) who had undergone PVI . Echocardiography was performed within two days before PVI . Maximum (Max‐ LAV i) and minimum LA volume index (Min‐ LAV i) were calculated with the biplane modified Simpson's method, and then normalized to the body surface area. On the basis of previous findings, the predefined cutoff value of Max‐ LAV i for AF recurrence was set at Max‐ LAV i ≥ 34 mL/m 2 . Δ LA volume index (Δ LAV i) was also calculated as Max‐ LAV i minus Min‐ LAV i. The follow‐up period after PVI was 24 months. Results AF recurrence was observed in 35 patients. Multivariate logistic regression analysis showed that Δ LAV i (odds ratio [ OR ]: 1.131; 95% confidence interval [ CI ]: 1.057‐1.221; P < 0.001) was an independent predictor of AF recurrence. Sequential logistic regression models for predicting AF recurrence revealed that a model based on clinical variables including age, gender and AF duration ( χ 2 = 1.65) was improved by the addition of Max‐ LAV i ≥ 34 mL/m 2 ( χ 2 = 13.8; P < 0.001), and further improved by the addition of Δ LAV i ( χ 2 = 18.2; P = 0.036). Of note is that only 1.02 ± 0.10 minutes per patient was needed to obtain a comprehensive LA assessment that included Max‐ LAV i, Min‐ LAV i, and Δ LAV i. Conclusion This easy‐to‐use comprehensive simplified LA approach from routine echocardiography may well have clinical implications for better management of PAF patients.