Journal Article

Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation: predictive value after ablative treatment

Solowjowa, Natalia, Gerds-Li, Jin-Hong, Nedios, Sotirios, Tang, Min, Kriatselis, Charalampos, Roser, Mattias, Fleck, Eckart

2011

Overview

Introduction Atrial fibrillation (AF) is associated with electroanatomical remodelling of the left atrium (LA), especially with LA dilatation. However, little is known about the changes of the three-dimensional structure of the LA, regarding the type of atrial fibrillation and their prognostic value after an ablative treatment. Methods One hundred fifteen patients (72 males, 59 ± 11 years) with an indication for AF ablation were prospectively included. Preoperatively, all patients underwent cardiac computed tomography (CCT). A reconstruction of the LA and the pulmonary veins (PV) was made from CCT data using specialized software (EP PreNavigator, Philips, The Netherlands). Left atrial volume (LAV) after exclusion of the atrial appendage (LAA) and the PV was determined. The LA was then arbitrarily divided by a cutting plane, between the anterior segment of the PV ostia and the atrial appendage and parallel to the posterior wall, to anterior-(LA-Ant.) and posterior-LA (LA-Post.). The ratio LA-Ant./LAV was defined as asymmetry index (ASI). The cardiac CT data, of 25 patients (11 women, 47 ± 11 years) without organic heart disease, were similarly studied for the same parameters, as a control group. Results Patients with paroxysmal AF ( n  = 63) had significantly higher LAV (131 ± 31 vs. 95 ± 18 ml, p  < 0.001) and higher ASI (61 ± 6 % vs. 57 ± 4, p  = 0.002) than the control group. Patients with persistent AF ( n  = 34) in comparison with paroxysmal AF showed significantly larger volumes (154 ± 44 vs. 131 ± 31 ml, p  = 0.007) but no difference in the ASI (60 ± 8% vs. 61 ± 6%, p  = 0.63). Finally, patients with long-term persistent AF ( n  = 18) showed a bigger asymmetry index than the patients with persistent AF (64 ± 5% vs. 60 ± 8%, p  = 0.06) but no significant difference in volumes (161 ± 21 vs. 154 ± 44 ml, p  = 0.49). LAA and partial LA volumes had a dilatation pattern similar to LAV. During a follow-up of over 25 ± 7 months, AF recurred in 31 (27%) patients. Multivariate analysis showed that ASI and LAV were the only two significant predictors of AF recurrence after ablative treatment. Independent of LAV, an ASI over 60% predicted AF recurrence with 74% sensitivity and 73% specificity. Conclusion Characteristic differences of both left atrial volume and geometry exist between the different forms of atrial fibrillation (paroxysmal, persistent and long-term persistent). The asymmetry index is a simple parameter derived by cardiac CT data that reflects these changes of LA geometry and predicts the outcome after the pulmonary vein isolation.

• Publisher: Springer US,Springer Nature B.V
• Subject: Aged / Analysis of Variance / Atrial Fibrillation - diagnostic imaging / Atrial Fibrillation - surgery / Atrial Function, Left - physiology / Cardiology / Catheter Ablation - methods / Chi-Square Distribution / Electrocardiography - methods / Female / Humans / Imaging, Three-Dimensional / Male / Medicine / Medicine & Public Health / Middle Aged / Multivariate Analysis / Observer Variation / Predictive Value of Tests / Prospective Studies / Regression Analysis / Severity of Illness Index / Single-Blind Method / Tomography, X-Ray Computed - methods