Novel Method for Risk Stratification of Major Adverse Clinical Events Using Pre- and Post-Ablation Left Atrial Volume...

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Persistent atrial fibrillation (AF) poses significant risks for major adverse clinical events (MACE).
• The prognostic value of left atrial volume index (LAVI) changes after catheter ablation (CA) in persistent AF patients is not well-established.
• Understanding LAVI dynamics post-CA is crucial for long-term risk stratification.

Purpose of the Study:

• To investigate the association between pre- and post-catheter ablation (CA) left atrial volume index (LAVI) and long-term major adverse clinical events (MACE) in patients with persistent atrial fibrillation (AF).
• To identify specific LAVI patterns that predict adverse outcomes following CA.

Main Methods:

• Retrospective analysis of 150 patients with persistent AF undergoing their first CA.
• Calculation of pre-CA LAVI (during AF) and post-CA LAVI (3 months post-CA, in sinus rhythm) using echocardiography.
• Comparison of MACE incidence across subgroups defined by pre-CA LAVI (>45.5 mL/m²) and post-CA LAVI (>46.5 mL/m²) thresholds.

Main Results:

• A subgroup with elevated pre-CA LAVI (>45.5 mL/m²) and elevated post-CA LAVI (>46.5 mL/m²) exhibited significantly higher MACE incidence (P=0.002).
• This specific LAVI pattern was identified as an independent predictor of MACE via multivariate analysis.
• Patients with elevated pre-CA LAVI but normalized post-CA LAVI showed comparable MACE rates to those with normal pre-CA LAVI and demonstrated significant LAVI reduction.

Conclusions:

• The combination of pre- and post-CA LAVI measurements provides valuable risk stratification for long-term MACE development after CA in persistent AF.
• Monitoring LAVI changes post-ablation can aid in identifying high-risk patients needing closer follow-up.