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Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion: An
Armin Osmanagic1, Sören Möller2, Azra Osmanagic3
1Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark.
Insights
A more spherical left atrium, indicated by a high left atrial sphericity index (LASI >0.9), predicts atrial fibrillation (AF) recurrence after direct-current cardioversion (DCC). This finding aids in managing persistent AF patients post-DCC.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Direct-current cardioversion (DCC) is frequently used for rhythm control in persistent atrial fibrillation (AF).
- AF recurrence post-DCC is common, occurring in up to 57% of patients within one month.
- Predictive markers for AF recurrence after DCC are crucial for patient management.
Purpose of the Study:
- To evaluate the left atrial sphericity index (LASI) measured by 2D transthoracic echocardiography (TTE) as a predictor of AF recurrence.
- To determine if baseline LASI can identify patients at higher risk of AF returning after successful DCC.
Main Methods:
- 124 patients with persistent AF (<120 days) underwent successful DCC.
- Baseline 2D TTE was performed to calculate LASI (left atrial width/length ratio).
- Patients received only beta-blockers; no other antiarrhythmic drugs were used.
Main Results:
- A spherical left atrium (LASI >0.9) was a strong predictor of AF recurrence.
- The odds ratio for recurrence with LASI >0.9 ranged from 4.1 to 7.6 (P < 0.005).
- Receiver operating characteristic analysis confirmed LASI's predictive power, with a cutoff of 0.9 chosen for high specificity.
Conclusions:
- Baseline LASI >0.9 is significantly associated with increased AF recurrence.
- This echocardiographic parameter can help stratify risk in persistent AF patients undergoing DCC.
- LASI measurement offers a valuable, non-invasive tool for predicting long-term outcomes after cardioversion.
Background:
Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial sphericity index (LASI) acquired by 2-dimensional transthoracic echocardiography (TTE) could be used as a predictor of AF recurrence after successful DCC.
Hypothesis:
A baselline LASI assessed by 2D TTE can predict AF recurrence after successful DCC in patients with persistent AF.
Methods:
A total of 124 consecutive patients with persistent AF lasting <120 days underwent successful DCC. Other than β-blockers, no other antiarrhythmic treatment was administered. Prior to DCC, all patients underwent thorough TTE, and LASI was calculated as the fraction of the left atrial width/length of the largest possible left atrial volume in a 4-chamber view. The primary outcome was a TTE-estimated baseline LASI as a predictor of AF recurrence after successful DCC for persistent AF.
Results:
Anatomically, a more spherical shape of the left atrium (LASI >0.9) proved to be a strong and independent predictor of AF recurrence, with an odds ratio between 4.1 (95% confidence interval: 1.6-11.9, P = 0.005) and 7.6 (95% confidence interval: 3.3-19.7; P = 7.2 × 10(-6) ). The receiver operating characteristic curve indicated good power for distinguishing between recurring and nonrecurring AF, and we chose a cutoff of 0.9 because high specificity was a priority for clinical reasons.
Conclusions:
In conclusion, baseline LASI >0.9 was associated with significantly greater AF recurrence throughout the 12-month follow-up period.
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