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Prognostic implication of left atrial sphericity in atrial fibrillation patients undergoing radiofrequency catheter ablation

Authors
 Jeonggeun Moon  ;  Hye‐Jeong Lee  ;  Jongwook Yu  ;  Hui‐Nam Pak  ;  Jong‐Won Ha  ;  Moon‐Hyoung Lee  ;  Young Jin Kim  ;  Boyoung Joung 
Citation
 PACE - Pacing and Clinical Electrophysiology, Vol.40(6) : 713-720, 2017 
Journal Title
 PACE - Pacing and Clinical Electrophysiology 
ISSN
 0147-8389 
Issue Date
2017
MeSH
Atrial Fibrillation/epidemiology ; Atrial Fibrillation/pathology* ; Atrial Fibrillation/surgery* ; Catheter Ablation ; Female ; Humans ; Imaging, Three-Dimensional/methods* ; Male ; Middle Aged ; Multidetector Computed Tomography/methods* ; Outcome Assessment (Health Care)/methods* ; Prevalence ; Prognosis ; Recurrence ; Reproducibility of Results ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Single-Blind Method ; Treatment Failure ; Treatment Outcome
Keywords
ablation ; atrial fibrillation ; left atrium ; pressure ; prognosis
Abstract
BACKGROUND: Left atrial (LA) sphericity can predict recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). We sought to reconfirm the prognostic role of atrial sphericity after RFCA of atrial fibrillation (AF), assess any relationship between the atrial pressure and sphericity, and determine the characteristics of the patients for whom atrial sphericity was most highly predictive. METHODS: All 148 nonvalvular AF patients (57 ± 11 years, 121 men, 95 paroxysmal AF [PaAF]) who underwent RFCA were enrolled. The LA volume (LAV) was determined and LA sphericity assessed from three-dimensional computed tomographic images. The preprocedural mean LA pressure (mLAP) was measured. RESULTS: After a 3-month blanking period, AF/atrial tachycardia (AT) recurrences within 1 year were documented in 38 patients (26%). Patients with recurrence had a greater LAV (124 ± 35 mL vs 151 ± 45 mL, P < 0.001) and LA sphericity (0.669 ± 0.040 vs 0.684 ± 0.038, P = 0.041). In patients with smaller LAs (LAV < 125 mL), LA sphericity predicted AF/AT recurrences (odds ratio [OR]: 1.030 [for each 0.001 increase], 95% confidence interval [CI]: 1.008-1.053, P = 0.007), whereas the LAV did not. In patients with larger LAs (LAV ≥ 125 mL), the LAV could predict recurrence (OR: 1.021, 95% CI: 1.001-1.041, P = 0.036), while the LA sphericity could not. The LA sphericity and mLAP are linearly correlated (r = 0.345, P < 0.022) in persistent AF, but not PaAF. CONCLUSIONS: LA spherical change precedes severe LA enlargement in AF. It predicts 1-year AF/AT recurrence after RFCA and is more important than the LA size in patients with less severe LA enlargement.
Full Text
https://onlinelibrary.wiley.com/doi/abs/10.1111/pace.13088
DOI
10.1111/pace.13088
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김영진(Kim, Young Jin) ORCID logo https://orcid.org/0000-0002-6235-6550
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
이혜정(Lee, Hye Jeong) ORCID logo https://orcid.org/0000-0003-4349-9174
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160497
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