Abstract
Purpose
Left atrium (LA) size is a common predictor of ablation outcomes in atrial fibrillation (AF), but different LA diameters have not been adequately studied yet. We aimed to find the best predictor of ablation outcomes using single-linear LA dimensions by computed tomography (CT) or echocardiography.
Methods
Patients (n = 103, 72 males, 59 ± 9 years) undergoing AF ablation were analyzed. LA diameter (LA-D) was measured by transthoracic echocardiography (parasternal long axis). After 3D reconstruction of CT data (EnSite Verismo, SJM, MN), maximal LA dimensions were measured on a coronal plane (superior-inferior, SI, and transversal, TV) and a sagittal plane (anterior-posterior, AP). Volume (LAV) was rendered after LA appendage and pulmonary vein exclusion.
Results
Patients with persistent AF (n = 40) had significantly larger LA size than those with paroxysmal AF (n = 63). After 26 ± 14 months, 31 (30 %) patients had AF recurrence. Univariate Cox regression analysis revealed that LA-D, LA-SI, LA-TV, LAV, and LAV-index (LAV/body surface area) were associated with AF recurrence. Multivariate Cox regression analysis revealed that LAV was the strongest independent predictor of AF recurrence (HR = 1.011 per ml, 95 % CI 1.003–1.020, p = 0.002). LA-TV had the best correlation with LAV (r = 0.69, p < 0.01) and was the strongest single-linear predictor (HR = 1.07 per mm, 95 % CI 1.022–1.121, p = 0.004). Independent of LA-D, an LA-TV>74.5 mm predicted AF recurrence similarly to LAV>126 ml.
Conclusions
LA dilatation, especially on the coronal plane, is associated with reduced long-term success after catheter ablation. LA-TV is the best linear predictor of AF recurrence, stronger than the commonly used LA-D.
Similar content being viewed by others
References
Tsang, M. Y., Barnes, M. E., & Tsang, T. S. (2012). Left atrial volume: clinical value revisited. Current Cardiology Reports, 14(3), 374–380.
Berruezo, A., Tamborero, D., Mont, L., Benito, B., Tolosana, J. M., Sitges, M., et al. (2007). Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. European Heart Journal, 28(7), 836–841.
Shin, S. H., Park, M. Y., Oh, W. J., Hong, S. J., Pak, H. N., Song, W. H., et al. (2008). Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation. Journal of the American Society of Echocardiography, 21(6), 697–702.
Abecasis, J., Dourado, R., Ferreira, A., Saraiva, C., Cavaco, D., Santos, K. R., et al. (2009). Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace, 11(10), 1289–1294.
Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., et al. (2012). 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. European Heart Journal, 33(21), 2719–2747.
Badano, L. P., Pezzutto, N., Marinigh, R., Cinello, M., Nucifora, G., Pavoni, D., et al. (2008). How many patients would be misclassified using M-mode and two-dimensional estimates of left atrial size instead of left atrial volume? A three-dimensional echocardiographic study. Journal of Cardiovascular Medicine (Hagerstown, Md.), 9(5), 476–484.
Nedios, S., Tang, M., Roser, M., Solowjowa, N., Gerds-Li, J. H., Fleck, E., et al. (2011). Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation: predictive value after ablative treatment. Journal of Interventional Cardiac Electrophysiology, 32(2), 87–94.
Sohns, C., Sohns, J. M., Vollmann, D., Luthje, L., Bergau, L., Dorenkamp, M., et al. (2013). Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation. European Heart Journal – Cardiovascular Imaging, 14(7), 684–691.
Bisbal, F., Guiu, E., Calvo, N., Marin, D., Berruezo, A., Arbelo, E., et al. (2013). Left atrial sphericity: a new method to assess atrial remodeling. Impact on the outcome of atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 24(7), 752–759.
Tsang, T. S., Abhayaratna, W. P., Barnes, M. E., Miyasaka, Y., Gersh, B. J., Bailey, K. R., et al. (2006). Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? Journal of the American College of Cardiology, 47(5), 1018–1023.
Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., et al. (2006). Recommendations for chamber quantification. European Journal of Echocardiography, 7(2), 79–108.
Mosteller, R. D. (1987). Simplified calculation of body-surface area. The New England Journal of Medicine, 317(17), 1098.
Eitel, C., Hindricks, G., Sommer, P., Gaspar, T., Kircher, S., Wetzel, U., et al. (2010). Circumferential pulmonary vein isolation and linear left atrial ablation as a single-catheter technique to achieve bidirectional conduction block: the pace-and-ablate approach. Heart Rhythm, 7(2), 157–164.
Hoffmeister, P. S., Chaudhry, G. M., Mendel, J., Almasry, I., Tahir, S., Marchese, T., et al. (2007). Evaluation of left atrial and posterior mediastinal anatomy by multidetector helical computed tomography imaging: relevance to ablation. Journal of Interventional Cardiac Electrophysiology, 18(3), 217–223.
Sanfilippo, A. J., Abascal, V. M., Sheehan, M., Oertel, L. B., Harrigan, P., Hughes, R. A., et al. (1990). Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation, 82(3), 792–797.
Vandenberg, B. F., Weiss, R. M., Kinzey, J., Acker, M., Stark, C. A., Stanford, W., et al. (1995). Comparison of left atrial volume by two-dimensional echocardiography and cine-computed tomography. The American Journal of Cardiology, 75(10), 754–757.
Helms, A. S., West, J. J., Patel, A., Lipinski, M. J., Mangrum, J. M., Mounsey, J. P., et al. (2009). Relation of left atrial volume from three-dimensional computed tomography to atrial fibrillation recurrence following ablation. The American Journal of Cardiology, 103(7), 989–993.
Montefusco, A., Biasco, L., Blandino, A., Cristoforetti, Y., Scaglione, M., Caponi, D., et al. (2010). Left atrial volume at MRI is the main determinant of outcome after pulmonary vein isolation plus linear lesion ablation for paroxysmal-persistent atrial fibrillation. Journal of Cardiovascular Medicine (Hagerstown, Md.), 11(8), 593–598.
Hauser, T. H., McClennen, S., Katsimaglis, G., Josephson, M. E., Manning, W. J., & Yeon, S. B. (2004). Assessment of left atrial volume by contrast enhanced magnetic resonance angiography. Journal of Cardiovascular Magnetic Resonance, 6(2), 491–497.
Hof, I., Arbab-Zadeh, A., Scherr, D., Chilukuri, K., Dalal, D., Abraham, T., et al. (2009). Correlation of left atrial diameter by echocardiography and left atrial volume by computed tomography. Journal of Cardiovascular Electrophysiology, 20(2), 159–163.
Parikh, S. S., Jons, C., McNitt, S., Daubert, J. P., Schwarz, K. Q., & Hall, B. (2010). Predictive capability of left atrial size measured by CT, TEE, and TTE for recurrence of atrial fibrillation following radiofrequency catheter ablation. Pacing and Clinical Electrophysiology, 33(5), 532–540.
Shin, S. Y., Yong, H. S., Na, J. O., Choi, C. U., Kim, S. H., Kim, J. W., et al. (2012). A simplified method to determine left atrial volume and transport function using multi-slice computed tomography in patients with atrial fibrillation: comparison with transthoracic echocardiography. The International Journal of Cardiovascular Imaging, 28(5), 1205–1216.
von Bary, C., Dornia, C., Eissnert, C., Nedios, S., Roser, M., Hamer, O. W., et al. (2012). Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 34(2), 181–188.
den Uijl, D. W., Tops, L. F., Delgado, V., Schuijf, J. D., Kroft, L. J., de Roos, A., et al. (2011). Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. The American Journal of Cardiology, 107(2), 243–249.
Avelar, E., Durst, R., Rosito, G. A., Thangaroopan, M., Kumar, S., Tournoux, F., et al. (2010). Comparison of the accuracy of multidetector computed tomography versus two-dimensional echocardiography to measure left atrial volume. The American Journal of Cardiology, 106(1), 104–109.
Al-Mohaissen, M. A., Kazmi, M. H., Chan, K. L., & Chow, B. J. (2013). Validation of two-dimensional methods for left atrial volume measurement: a comparison of echocardiography with cardiac computed tomography. Echocardiography, 30(10), 1135–1142.
Acknowledgments
The authors would like to thank Dr. Hedi Razavi, Ph.D., for her valuable editorial assistance.
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nedios, S., Kosiuk, J., Koutalas, E. et al. Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 43, 237–244 (2015). https://doi.org/10.1007/s10840-015-0010-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-015-0010-8