Journal Article

Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation

Christian Sohns, Jan M. Sohns, Dirk Vollmann, Lars Lüthje, Leonard Bergau, Marc Dorenkamp, Paul A. Zwaka, Gerd Hasenfuß, Joachim Lotz and Markus Zabel

in European Heart Journal - Cardiovascular Imaging

Published on behalf of European Society of Cardiology

Volume 14, issue 7, pages 684-691
Published in print July 2013 | ISSN: 2047-2404
Published online February 2013 | e-ISSN: 2047-2412 | DOI: http://dx.doi.org/10.1093/ehjci/jet017
Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation

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Aims

This study aimed to identify whether left atrial (LA) volume assessed by multidetector computed tomography (MDCT) is related to the long-term success of pulmonary vein ablation (PVA). MDCT is used to guide PVA for the treatment of atrial fibrillation (AF). MDCT permits accurate sizing of LA dimensions.

Methods and results

We analysed data from 368 ablation procedures of 279 consecutive patients referred for PVA due to drug-refractory symptomatic AF (age 62 ± 10; 58% men; 71% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 64-MDCT scan for assessment of LA and PV anatomy, LA thrombus evaluation, LA volume estimation, and electroanatomical mapping integration. Within a mean follow-up of 356 ± 128 days, 64% of the patients maintained sinus rhythm after the initial ablation, and 84% when including repeat PVA. LA diameter (P = 0.004), LA volume (P = 0.002), and type of AF (P = 0.001) were independent predictors of AF recurrence in univariate analysis. There was a relatively low correlation between the echocardiographic LA diameter and LA volume from MDCT (P = 0.01, r = 0.5). In multivariate analysis, paroxysmal AF (P < 0.006) and LA volume below the median value of 106 mL (P = 0.042) were significantly associated with the success of PVA, whereas LA diameter was not (P = 0.245). Analysing receiver-operator characteristics, the area under the curve for LA volume was 0.73 (P = 0.001) compared with 0.60 (P = 0.09) for LA diameter from echocardiography.

Conclusion

LA volume assessed by MDCT is a better predictor of AF recurrence after PVA than echocardiograpic LA diameter and can be derived from the pre-procedural imaging data set.

Keywords: Atrial fibrillation; Pulmonary vein ablation; Multidetector computed tomography; Left atrium

Journal Article.  4731 words.  Illustrated.

Subjects: Cardiovascular Medicine

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