Journal Article

Impact of left atrial fibrosis and left atrial size on the outcome of catheter ablation for atrial fibrillation

Delgado, Victoria, Bax, Jeroen J, den Uijl, Dennis W, Tops, Laurens F, Trines, Serge A, Schalij, Martin J, Bertini, Matteo, van de Veire, Nico R, Zeppenfeld, Katja

2011

Overview

BackgroundLeft atrial (LA) dilatation is an important risk factor for recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). However, the clinical applications to select patients eligible for RFCA according to LA size is limited. Additional pre-procedural assessment of LA fibrosis might improve patient selection for RFCA.ObjectiveTo investigate the impact of LA size and LA fibrosis on the outcome of RFCA for AF.MethodsOne hundred and seventy consecutive patients undergoing RFCA for AF were studied. LA size was assessed by measuring maximum LA volume index on echocardiography. LA wall ultrasound reflectivity was assessed by measuring echocardiography-derived calibrated integrated backscatter (IBS) as a surrogate of LA fibrosis.ResultsAfter 12±3 months' follow-up, 103 patients (61%) had maintained sinus rhythm and 67 patients (39%) had recurrence of AF. Univariate Cox analyses identified LA wall ultrasound reflectivity, as well as LA size and type of AF, as predictors of AF recurrence after RFCA. Importantly, multivariate analyses showed that LA wall ultrasound reflectivity remained a strong predictor after correction for LA size and type of AF. Moreover, LA wall ultrasound reflectivity provided an incremental value in predicting outcome of RFCA over LA size and type of AF (increment in global χ2=61.6, p<0.001).ConclusionAssessment of LA fibrosis using two-dimensional echocardiography-derived calibrated IBS can be useful to predict AF recurrence after RFCA. Combined assessment of LA wall ultrasound reflectivity and LA size improves the identification of patients with a high likelihood for a successful ablation.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: ablation / Aged / Atrial fibrillation / Atrial Fibrillation - diagnostic imaging / Atrial Fibrillation - pathology / Atrial Fibrillation - physiopathology / Atrial Fibrillation - surgery / Biological and medical sciences / Cardiac arrhythmia / Cardiac dysrhythmias / cardiac remodelling / Cardiology. Vascular system / Catheter Ablation / Catheters / echocardiography / Echocardiography - methods / Female / Fibrosis - diagnostic imaging / Follow-Up Studies / Heart / Heart Atria - diagnostic imaging / Heart Atria - pathology / Heart attacks / Humans / left atrial fibrosis / left atrial size / Male / Medical sciences / Middle Aged / Multivariate Analysis / Predictive Value of Tests / Prognosis / Proportional Hazards Models / radiofrequency ablation / Secondary Prevention / Sensitivity and Specificity / Studies / Treatment Outcome / Ultrasonic imaging