Left Atrial Volume Best Predicts Recurrence after Catheter Ablation in Patients with Persistent and Longstanding Persistent Atrial Fibrillation

INTRODUCTION: Patients with persistent and longstanding persistent atrial fibrillation (AF) have a higher recurrence rate after antral pulmonary vein isolation (PVI). We sought to determine the clinical, invasive, and noninvasive diastolic function parameters that are associated with AF recurrence after ablation in patients with persistent and longstanding persistent nonvalvular AF. METHODS AND RESULTS: We studied 125 consecutive patients with persistent and longstanding persistent AF who underwent antral PVI at our institution between April 2009 and April 2011. Standard clinical parameters, left atrial (LA) pressure measured at transseptal puncture, and standard diastolic function parameters on transthoracic echocardiographic (TTE) parameters were assessed. TTE was performed in sinus rhythm the first day following radiofrequency catheter ablation. Ablation eliminated AF in 83 of 125 (66.4%) patients (mean age 61.3 ± 8.9, 81% male) during 17.8 ± 7.7 months of follow-up. Using logistic regression analysis, AF duration prior to ablation (P = 0.04, odds ratio OR: 1.03, 95% confidence interval CI 1.0-1.06) was found to be the only clinical parameter significantly associated with AF recurrence. According to multiple logistic regression analysis, the indexed LA minimum volume of 26 cm(3) /m(2) (P = 0.009, OR: 4.9 95% CI 1.5-16.2) was the only independent imaging parameter associated with AF recurrence. CONCLUSION: Indexed minimal LA volume is highly associated with ablation success in patients with persistent and longstanding persistent AF.