The Right Atrial Area as a New Factor to Predict Successful Pulmonary Vein Isolation: an Emergent Predictor Variable
An emergent predictor variable.
Keywords:
Atrial fibrillation, Pulmonary vein isolationAbstract
Up to now, few factors have been identified to predict successful pulmonary vein isolation, none of which with high predictive values. The objective of our study was to compare different predictive factors of atrial fibrillation recurrence after pulmonary vein isolation,including new parameters of the right atrium (area and index volume). We retrospectively analysed data from 66 patients and included echocardiogram parameters performed within 18 months prior to the ablation procedure. We excluded patients with left ventricular dysfunction (defined as a left ventricular ejection fraction < 50%); previous diagnostic of cardiomyopathy; severe valvular heart disease; severe pulmonary hypertension; or those with poor image quality in the echocardiogram. We considered atrial fibrillation recurrence to be the presence of atrial fibrillation of 30 seconds or longer demonstrated by a standard electrocardiogram or in a 24-hour Holter electrocardiogram within a year after the ablation procedure. We found that the right atrium area (odds ratio = 1.52; 95% confidence interval 0.95–2.43, P = 0.08) and a previous pulmonary vein isolation procedure (odds ratio = 0.21; 95% confidence interval 0.04–1.01, P = 0.05) were nearly statistically significant predictors of successful atrial fibrillation ablation at one year. Although our study was limited because of a low number of patients and because it is a retrospective analysis, we found that a higher right atrial area may be related to the late recurrence of atrial fibrillation. This tendency may be useful in predicting patient outcomes.
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References
References.
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2020; 00, 1_125.
Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018 Feb 1;378(5):417-427.
Berruezo A, Tamborero D, Mont L, Benito B, Tolosana JM, Sitges M,et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007Apr;28(7):836-41.
Miyazaki S, Kuwahara T, Kobori A, Takahashi Y, Takei A, Sato A, et al. Catheter ablation of atrial fibrillation in patients with valvular heart disease: long-term follow-up results. J Cardiovasc Electrophysiol. 2010 Nov;21(11):1193-8.
Balk EM, Garlitski AC, Alsheikh-Ali AA, Terasawa T, Chung M, Ip S. Predictors of atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review. J Cardiovasc Electrophysiol. 2010 Nov;21(11):1208-16.
Hussein AA, Saliba WI, Martin DO, Shadman M, Kanj M, Bhargava M,et al. Plasma B-type natriuretic peptide levels and recurrent arrhythmia after successful ablation of lone atrial fibrillation. Circulation. 2011 May 17;123(19):2077-82.
Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004 Jul 27;110(4):364-7.
Pappone C, Oreto G, Rosanio S, Vicedomini G, Tocchi M, Gugliotta F, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104:2539.
Marine JE. Catheter ablation therapy for supraventricular arrhythmias. JAMA 2007; 298:2768.
Kamel H, Okin PM, Longstreth WT, Elkind MS, Soliman EZ. Atrial cardiopathy: a broadened concept of left atrial thromboembolism beyond atrial fibrillation. Future Cardiol. 2015 May; 11(3): 323–331.
Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA, et al. Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation. 1990;82:792–797.
Aryana A, Kenigsberg DN, Kowalski M, Koo CH, Lim HW, O'Neill PG, et al. Verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: Results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance). Heart Rhythm. 2017 Sep;14(9):1319-1325.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults:
An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.
Akutsu Y, Kaneko K, Kodama Y, Suyama J, Li HL, Hamazaki Y, et al. Association Between Left and Right Atrial Remodeling With Atrial Fibrillation Recurrence After Pulmonary Vein Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation. A Pilot Study. Circ Cardiovasc Imaging. 2011;4:524-531.
Luong C, Thompson DJS, Bennett M, Gin K, Jue J, Barnes ME, et al. Right atrial volume is superior to left atrial volume for prediction of atrial fibrillation recurrence after direct current cardioversion. Can J Cardiol. 2015 Jan;31(1):29-35.
Xie E, Yu R, Ambale-Venkatesh B, Bakhshi H, Heckbert SR, Soliman EZ, et al. Association of right atrial structure with incident atrial fibrillation: a longitudinal cohort cardiovascular magnetic resonance study from the Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Magn Reson 22, 36 (2020).
Takagi T, Nakamura K, Asami M, Toyoda Y, Enomoto Y, Moroi M, et al. Impact of right atrial structural remodeling on recurrence after ablation for atrial fibrillation. J Arrhythm. 2021 May 6;37(3):597-606.
