Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation
Open Access
- 23 July 2009
- journal article
- clinical trial
- Published by Oxford University Press (OUP) in EP Europace
- Vol. 11 (10), 1289-1294
- https://doi.org/10.1093/europace/eup198
Abstract
Catheter ablation (CA) of atrial fibrillation (AF) might be a definitive curative therapy for selected groups of patients (pts). However, current ablation protocols are not standardized and predictors of CA success and sinus rhythm maintenance are not clearly defined. To evaluate whether left atrium (LA) volume quantification provided by multi-detector computed tomography (MDCT) might predict the success of pulmonary vein (PV) isolation procedure. We evaluated 99 pts, 66 male, mean age 54.4 ± 10.1 years, referred for CA because of drug resistant AF. All pts were submitted to 64-slice MDCT scan for electroanatomic mapping integration, pulmonary veins anatomy delineation, LA thrombi exclusion, and LA volume estimation. Complete isolation of all the PVs was always performed with eventual cavo-tricuspid isthmus ablation. For a mean follow-up period (Fup) of 16.7 ± 6.6 months, clinical success was assessed after a 3-month blanking period. Anti-arrhythmic drug therapy was discontinued or modified at the clinician's criteria. At the end of the Fup, 29 pts suspended anti-arrhythmic drug therapy and 26% were of oral anticoagulation. Univariate analysis showed that the probability of AF relapse after CA was higher in pts with non-paroxysmal forms of AF. The probability of relapse was significantly higher in pts with LA volumes greater than 100 mL when assessed by MDCT. We found that the LA volume of 145 mL was a good cut-off value for AF recurrence prediction. Patients with LA volumes greater than 145 mL had significantly higher recurrence rates of arrhythmia, even when adjusted for the effect of age, gender, body mass index, hypertension, and type of AF. Left atrium volume estimated by MDCT may be useful to identify pts in whom successful AF ablation can be achieved with simpler ablation procedures, restricted to PV isolation.Keywords
This publication has 16 references indexed in Scilit:
- Novel non-pharmacological approaches for antiarrhythmic therapy of atrial fibrillationEP Europace, 2008
- ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults With Nonvalvular Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation) Developed in Collaboration With the Heart Rhythm SocietyJournal of the American College of Cardiology, 2008
- Long-term follow-up after radiofrequency catheter ablation for atrial fibrillationEP Europace, 2008
- Atrial-fibrillation ablation should be considered first-line therapy for some patientsCurrent Opinion in Cardiology, 2008
- Catheter Ablation for Atrial FibrillationCirculation, 2007
- HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm SocietyHeart Rhythm, 2007
- Cardiovascular Imaging in the Management of Atrial FibrillationJournal of the American College of Cardiology, 2006
- ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial FibrillationCirculation, 2006
- Predictors of Recurrence Following Catheter Ablation of Atrial Fibrillation Using an Irrigated‐Tip Ablation CatheterJournal of Cardiovascular Electrophysiology, 2004
- Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomographyJournal of the American College of Cardiology, 2003