Cardiac Computed Tomography-Derived Left Atrial Volume Index as a Predictor of Long-Term Success of Cryo-Ablation in Patients With Atrial Fibrillation - 05/01/21
, Hermann Blessberger, MD a, #, Alexander Nahler, MD a, Denis Hrncic, MD a, Alexander Fellner, MD a, Christian Reiter, MD a, Simon Hönig, MD a, Pierre Schmit, MD c, Franz Fellner, MD c, Thomas Lambert, MD a, Clemens Steinwender, MD aWhat's new? |
• | Long-term follow-up data in a cryo-ablation-naïve cohort revealed a success rate of 53.98%. |
• | Success depended on patients’ left atrial volume index (LAVI), as well as AF type and BMI. |
• | The results extend previous investigations and indicate that CT-derived LAVI is a valuable predictor. |
• | Current AF recurrence risk scores may underestimate the predictive power of CT-derived LAVI. |
Résumé |
Patients with symptomatic, drug-refractory atrial fibrillation (AF) are frequently treated with catheter ablation. Cryo-ablation has been established as an alternative to radiofrequency ablation but long-term outcome data are still limited. This study aimed at elucidating the influence of the left atrial volume index (LAVI), derived from cardiac computed tomography (cCT) data, on the long-term outcome of ablation-naïve AF patients, after their first cryo-ablation. 415 patients (n = 290 [69.90%] male, 60.00 [IQR: 53.00 to 68.00] years old) who underwent a cCT and subsequent cryo-ablation index procedure were included in this single centre retrospective data analysis. A composite end point was defined (AF on electrocardiogram and/or electric cardioversion and/or re-do). Patients were closely followed for a year and then contacted for long-term follow-up after a median of 53.00 months (IQR: 34.50 to 73.00). Statistical analyses of the outcome and predictors of AF recurrence were conducted. In 224 patients (53.98%) no evidence of AF recurrence could be found. LAVI differed significantly between the positive and adverse (AF recurrence) outcome group (49.96 vs 56.07 ml/m2, p < 0.001). Cox regression analyses revealed cCT LAVI (HR: 1.022, 95% CI: 1.013 to 1.031, p < 0.001), BMI (HR: 1.044, 95% CI: 1.005 to 1.084, p < 0.05) and the type of AF (HR: 1.838 for nonparoxysmal AF, 95% CI: 1.214 to 2.781, p < 0.01) to be effective predictors of AF recurrence. A prognostic cCT LAVI cut-off value of 51.99 ml/m2 was calculated and must be validated in future prospective studies. In conclusion, LAVI is an accurate, yet underutilized predictor of AF recurrence after pulmonary vein isolation with cryo-energy and scores for calculating AF recurrence or progression risks might underemphasize the importance of CT-derived LAVI as a predictive factor.
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| This research did not receive any specific grant. |
Vol 140
P. 69-77 - février 2021 Retour au numéro
Article précédent
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