Predictors of left atrial volume index reduction following cryoballoon-based pulmonary vein isolation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=160). Intervention: Cryoballoon-based pulmonary vein isolation. Primary outcome: Reduction in left atrial volume index (LAVIR) at 12 months.

Q: What does this research mean for the field?

Left atrial volume index reduction occurs in the majority of patients following cryoballoon pulmonary vein isolation, with younger age, absence of hypertension, mild mitral regurgitation, and absence of AF recurrence independently predicting this reverse remodeling. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Muhammed Ulvi Yalçın; Kadri Murat Gürses; Duygu Koçyiğit; Banu Evranos; Hikmet Yorgun; L. Şahiner; Ergün Barış Kaya; Mehmet Ali Oto; Kudret Aytemir

doi:10.1093/europace/euv102

May 21, 2015EP EuropaceOpen Access

Predictors of left atrial volume index reduction following cryoballoon-based pulmonary vein isolation

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Key result

Cryoballoon-based pulmonary vein isolation led to left atrial volume index reduction in 75% of patients; age, hypertension, mild mitral regurgitation, and AF recurrence were independent predictors.

Why the study?

There is a paucity of data about the predictors for left atrial volume index reduction after pulmonary vein isolation in atrial fibrillation patients.

What are the predictors of left atrial volume index reduction in patients with symptomatic atrial fibrillation undergoing cryoballoon-based pulmonary vein isolation?

Key Points

To identify independent clinical predictors of left atrial volume index reduction at 12 months in patients undergoing cryoballoon-based pulmonary vein isolation for atrial fibrillation.
Enrolled 160 patients (mean age 54.25 ± 7.66 years, 44.40% female) with symptomatic paroxysmal or persistent atrial fibrillation refractory to ≥1 antiarrhythmic drug in a prospective observational study.
All patients underwent cryoballoon-based pulmonary vein isolation and were followed up for 12 months, with left atrial volume calculated using the biplane area-length method.
Left atrial volume index reduction occurred in 120 of 160 patients (75.0%) at 12-month follow-up.
Independent predictors of left atrial volume index reduction were younger age (HR: 0.901, 95% CI: 0.828–0.981, P = 0.017), absence of hypertension (hypertension HR: 0.151, 95% CI: 0.048–0.471, P = 0.001), presence of mild mitral regurgitation (HR: 5.327, 95% CI: 1.489–19.058, P = 0.010), and absence of atrial fibrillation recurrence (AF recurrence HR: 0.017, 95% CI: 0.005–0.065, P < 0.001).

Study Design

Type

Observational (n=160)

Structured PICO

What are the predictors of left atrial volume index reduction in patients with symptomatic atrial fibrillation undergoing cryoballoon-based pulmonary vein isolation?

P

Population

160 patients with symptomatic paroxysmal or persistent AF despite ≥1 antiarrhythmic drug undergoing cryoballoon-based ablation, followed for 12 months.

E

Exposure

Cryoballoon-based pulmonary vein isolation (PVI)

O

Outcome

Reduction in left atrial volume index (LAVIR) at 12 monthssurrogate

Implication

Younger patients without hypertension or moderate mitral regurgitation are most likely to experience reverse left atrial remodeling following cryoballoon-based pulmonary vein isolation.

Abstract

AIMS: Ablation for atrial fibrillation (AF) has been suggested to be associated with 'reverse left atrial remodelling'. Reduction in left atrial volume index (LAVIR) is regarded as a determinant of reverse remodelling following pulmonary vein isolation (PVI). However, there is paucity on data about the predictors for LAVIR after PVI. In this study, we aimed to investigate predictors of LAVIR at 12 months in AF patients undergoing cryoballoon-based PVI. METHODS AND RESULTS: Patients with symptomatic paroxysmal or persistent AF despite ≥1 antiarrhythmic drug(s), who were scheduled for cryoballoon-based AF ablation procedure per the recent consensus recommendations, were enrolled and followed-up for 12 months in this prospective observational study. Left atrial volume was derived using the biplane area-length method. A total of 160 patients (54.25 ± 7.66 years, 44.40% female) were involved in the study. Reduction in left atrial volume index occurred in 120 patients. Age [hazard ratio (HR): 0.901, 95% confidence interval (CI): 0.828-0.981, P = 0.017], hypertension (HR: 0.151, 95% CI: 0.048-0.471, P = 0.001), mild mitral regurgitation (MR) (HR: 5.327, 95% CI: 1.489-19.058, P = 0.010), and AF recurrence (HR: 0.017, 95% CI: 0.005-0.065, P< 0.001) were found to be independent predictors for LAVIR. CONCLUSION: To the best of our knowledge, this is the largest study in the literature investigating the predictors of LAVIR following AF ablation. According to this data, younger patients without hypertension or moderate MR are most likely to experience LAVIR following ablation.

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Cite This Study

Yalçın et al. (2015) conducted an observational in Atrial fibrillation (n=160). Cryoballoon-based pulmonary vein isolation was evaluated on Reduction in left atrial volume index (LAVIR) at 12 months. Cryoballoon-based pulmonary vein isolation led to left atrial volume index reduction in 75% of patients; age, hypertension, mild mitral regurgitation, and AF recurrence were independent predictors.

synapsesocial.com/papers/6ab1ed6dbd887923dec468b4 https://doi.org/10.1093/europace/euv102