Key result
Higher LAVI linked to ~6% greater AF recurrence risk per ml/m2 after cardioversion.
Why the study?
This study was conducted to determine the clinical relevance of echocardiographically measured left atrial size to predict the recurrence of atrial fibrillation after direct current cardioversion.
Does increased left atrial volume index predict the recurrence of atrial fibrillation in patients undergoing direct current cardioversion?
Meta-Analysis (n=2,725)
Does increased left atrial volume index predict the recurrence of atrial fibrillation in patients undergoing direct current cardioversion?
Effect estimate: 6% increase in risk per 1 ml/m2 increase (95% CI 3-10)
p-value: p=< 0.001
Increased left atrial volume index is a strong echocardiographic predictor of atrial fibrillation recurrence following direct current cardioversion, with each 1 ml/m2 increase raising recurrence risk by 6%.
• Larger left atrial volume index more likely to have a recurrence of AF after direct current cardioversion. • Increase in left atrial volume index by 1 ml/m 2 increases the risk of overall recurrence of AF post DCCV by 6 %. • The utility of indexed LA volume measurements exceeds absolute LA volume. • Age and duration of atrial fibrillation predict recurrence of AF after direct current cardioversion. This systematic review and meta -analysis was conducted to determine the clinical relevance of echocardiographically measured left atrial (LA) size to predict the recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV). A search was performed on Medline (Ovid), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL) in Cochrane Library, Wiley and Web of Science (Clarivate) to identify relevant studies. Amongst the initial 4066 citations identified, 31 fulfilled the criteria for inclusion in the data analysis incorporating 2725 patients with a mean follow-up period of 6.5 months. The weighted mean left atrial volume index (LAVI) was 40.56 ml/m 2 (95 %CI:37.24–43.88) in the sinus rhythm (SR) maintenance group versus 48.69 ml/m 2 (95 % CI: 44.42–52.97) in the AF recurrence group with P value of < 0.001, left atrial diameter (LAD) was 42.06 mm (95 %CI: 41.08–43.05) in the SR maintenance group versus 45.13 mm (95 %CI: 44.09–46.16) in the AF recurrence group, P value < 0.001. Effect size analysis of LAVI showed that each unit increase in LAVI resulted in an increase in the risk of AF recurrence by 6 % (95 % CI: 3 %–10 %). Age and AF duration were also statistically significant between the two groups however comorbidities, use of beta blockers or amiodarone were not significantly different. This meta -analysis shows that AF duration, LAVI, LAD and age predict the risk of recurrence of atrial fibrillation post electrical cardioversion with LAVI being the most clinically relevant echocardiographic feature.
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Raniga et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=2,725). Left atrial volume index (LAVI) vs. Lower LAVI was evaluated on Recurrence of atrial fibrillation (6% increase in risk per 1 ml/m2 increase, 95% CI 3-10, p=< 0.001). Higher left atrial volume index was associated with atrial fibrillation recurrence after direct current cardioversion (48.69 vs 40.56 ml/m2; P<0.001), with a 6% risk increase per 1 ml/m2 increase.
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