Left atrium remodeling predicts late recurrence of paroxysmal atrial fibrillation after second generation cryoballoon ablation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Paroxysmal atrial fibrillation (n=209). Intervention: Left atrium minimum volume (LAmin). Primary outcome: Atrial fibrillation recurrence after a 3-month blanking period (HR 1.016, 95% CI 1.001-1.031, p=0.039).

Andreea Motoc; Juan‐Pablo Abugattas; Bram Roosens; Esther Scheirlynck; Benedicte Heyndrickx; Carlo de Asmundis; Gian‐Battista Chierchia; Steven Droogmans; Bernard Cosyns

doi:10.1186/s12947-018-0137-8

August 14, 2018Cardiovascular UltrasoundOpen Access

Left atrium remodeling predicts late recurrence of paroxysmal atrial fibrillation after second generation cryoballoon ablation

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Key result

Left atrium minimum volume was an independent predictor of atrial fibrillation recurrence after cryoballoon ablation (HR 1.016), with a cut-off of 23.69 mL yielding an 87.3% negative predictive value.

Figures

Why the study?

Does left atrium remodeling predict late recurrence of atrial fibrillation in patients with paroxysmal AF undergoing cryoballoon ablation?

Study Design

Type

Cohort (n=209)

Multicenter

No

Structured PICO

Does left atrium remodeling predict late recurrence of atrial fibrillation in patients with paroxysmal AF undergoing cryoballoon ablation?

P

Population

209 patients (mean age 56.1 years, 37.8% female) with paroxysmal atrial fibrillation undergoing second-generation cryoballoon ablation, followed for a mean of 16.9 months.

E

Exposure

Echocardiographic assessment of left atrial anatomical parameters (including LA minimum volume and LA superior-inferior diameter) prior to second-generation cryoballoon ablation

O

Outcome

Late recurrence of atrial fibrillation (documented AF episodes > 30 s after a 3-month blanking period)hard clinical

Main Result

Hazard Ratio: 1.016 (95% CI 1.001–1.031)

p-value: p=0.039

Limitations

Single center retrospective study, therefore results may not be generalized.
Addressed the prognostic value of LA anatomy only in paroxysmal AF and cannot be extrapolated to a persistent AF population.
LA volumes were based on only two orthogonal planes and related to geometrical assumptions.
Single center retrospective study, therefore results may not be generalized
Addressed the prognostic value of LA anatomy only in paroxysmal AF and cannot be extrapolated to a persistent AF population

Implication

Comprehensive echocardiographic assessment of the left atrium, including minimum volume and longitudinal diameter, improves the prediction of AF recurrence after cryoballoon ablation compared to standard anterior-posterior diameter alone.

Abstract

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Nowadays, AF ablation is a valuable treatment option. It has been shown that the left atrium (LA) diameter is a predictor of AF recurrence after cryoballoon ablation (CBA). Since it does not reflect the true LA size, we compared the role of different LA anatomical parameters using echocardiography for the prediction of AF recurrence after CBA. METHODS: We retrospectively included 209 patients (mean age 56.1 ± 13.6 years, male 62%) with paroxysmal AF undergoing CBA. A transthoracic echocardiography was performed in all patients. RESULTS: At a mean follow-up of 16.9 ± 6.3 months, AF recurred in 25.4% of the patients. LA anterior - posterior diameter (LAD), LA minimum volume (LAmin) and early AF recurrence were independent predictors of recurrence. Based on receiver operating characteristics, cut - off values for LAD and, LAmin were 41 mm, 23.69 mL, respectively. The negative predictive values for recurrence were 73% and 87.3% respectively. In patients with AF recurrence, a significant proportion (30.2%) showed LA longitudinal remodeling (LA superior - inferior diameter) even though classically measured LAD was normal. CONCLUSIONS: Longitudinal LA remodeling plays an additional role for predicting AF recurrence after CBA, in patients without LAD dilation. Moreover, LAmin had a high negative predictive value and was an independent predictor of AF recurrence. Therefore, a more complete LA anatomical assessment allows a better prediction of AF recurrences after CBA.

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Cite This Study

Motoc et al. (2018) conducted a cohort in Paroxysmal atrial fibrillation (n=209). Left atrium minimum volume (LAmin) was evaluated on Atrial fibrillation recurrence after a 3-month blanking period (HR 1.016, 95% CI 1.001-1.031, p=0.039). Left atrium minimum volume was an independent predictor of atrial fibrillation recurrence after cryoballoon ablation (HR 1.016), with a cut-off of 23.69 mL yielding an 87.3% negative predictive value.

synapsesocial.com/papers/6a7ba603050daa66a5df744b https://doi.org/10.1186/s12947-018-0137-8