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Prediction of improvement in left atrial function index after catheter ablation for atrial fibrillation
Takahiko Nagase1, Ritsushi Kato2, Shintaro Nakano1
1Department of Cardiology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
Insights
Catheter ablation improves left atrial function index in patients with atrial fibrillation (AF). However, left atrial maximum volume over 63.5 mL may prevent full recovery of this index post-ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Left atrial function index (LAFI) is a predictor of heart failure hospitalization and stroke.
- The impact of catheter ablation on LAFI in atrial fibrillation (AF) patients remains under-investigated.
Purpose of the Study:
- To investigate the effect of catheter ablation on left atrial function index.
- To identify predictors of LAFI recovery after catheter ablation for AF.
Main Methods:
- 55 patients with AF underwent catheter ablation and echocardiography pre- and post-procedure (12-24 months).
- Patients were grouped based on pre-ablation LAFI (<30 vs. ≥30).
- Clinical and echocardiographic variables were compared between groups.
Main Results:
- LAFI improved significantly 6 months post-ablation, plateauing thereafter.
- Pre-ablation chronic AF prevalence, LA emptying fraction, diameter, and volumes differed between groups.
- Multivariate analysis identified maximum left atrial volume as the sole predictor of post-ablation LAFI (p<0.05).
- ROC analysis determined a cutoff of 63.5 mL for maximum left atrial volume to predict LAFI recovery (sensitivity 0.75, specificity 0.75).
Conclusions:
- Catheter ablation effectively improves left atrial function index in AF patients.
- Patients with pre-ablation left atrial maximum volume >63.5 mL may not achieve normal LAFI post-ablation.
Purpose:
Although left atrial function index is reportedly a possible predictor of hospitalization for heart failure and of stroke irrespective of the presence or not of atrial fibrillation (AF), the effects of catheter ablation on left atrial function index have not yet been reported.
Methods:
We performed catheter ablation on 55 patients (age 56.6 ± 9.6 years; 44 men; 30 with paroxysmal and 25 with persistent, long-standing AF) and evaluated them by transthoracic echocardiography preoperatively and 3 monthly for 12-24 months after catheter ablation. We then compared clinical characteristics and echocardiographic variables before catheter ablation between two groups: the 42 subjects with the most recent left atrial function index <30 and the 13 in which it was ≥30.
Results:
Left atrial function index improved after catheter ablation in both groups, plateauing 6 months after the procedure. Univariate analysis showed statistically significant differences in the prevalence of chronic AF and left atrial emptying fraction, diameter, and maximum and minimum volume (prevalence of chronic AF, p < 0.05; others, p < 0.01) between the groups. Multivariate analysis showed that only maximum left atrial volume predicts left atrial function index after catheter ablation (p < 0.05). In addition, we used ROC analysis to calculate a cutoff value for LA maximum volume as a good predictor and found that a good cutoff value was 63.5 mL, the sensitivity and specificity being 0.75 and 0.75, respectively.
Conclusions:
Catheter ablation improves left atrial function index. However, in patients with left atrial maximum volume of over 63.5 mL on echocardiography, the index did not recover to within the normal range after catheter ablation.
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