Adjusted Left Atrial Emptying Fraction as a Predictor of Procedural Outcome after Catheter Ablation for Atrial Fibrillation

Abstract

A trial fibrillation (AF) is the most prevalent sustained atrial arrhythmia, and its prevalence increases with human age. Atrial fibrillation accounts for ap proximately one third of hospitalizations for cardiac rhythm disturbances. It is also the chief thromboembolic cause of stroke, and it is associated with a 2fold increase in mortality rates and a marked reduction in functional ability and quality of life.1 Despite the use of potent antiarrhythmic medications, AF recurrence after cardioversion remains frequent, leading to the need for catheter ablation (CA) proce dures. Since an exponential increase in CA for AF was documented, left atrial volume (LAV) and LAV index (LAVI) have proved to be powerful predictors of procedural outcomes and indicators of structural remodeling. 2,3Investigators have suggested that functional recovery of the left atrium (LA) might be more important than structural reverse remodeling of the LA after CA for AF be cause longterm anticoagulation is necessary in patients with contractile dysfunction of the LA, despite a maintained sinus rhythm. 4 Furthermore, investigators have shown that evaluating LA pump function combined with LAV enables a more accurate diag nosis of paroxysmal AF (PAF) than do conventional values. 5,6 However, data are sparse concerning the role of functional LA remodeling in predicting procedural outcomes.Identifying the arrhythmic substrates and evaluating the structural and functional changes in the atria by means of noninvasive methods can be useful in selecting patients for rhythmcontrol therapy, including CA, early in the disease process.7 Mul tislice computed tomography (MSCT) is an accurate method for evaluating LAV, with low interobserver variability. In this study, we used MSCT to quantify LA pump function and structural changes before CA. The aim of this work was to determine whether evaluating LA pump function with the use of MSCT is useful for predicting AF recurrence after CA. This approach would aid in selecting the most appropriate ablation approach for individual AFablation candidates. In addition, this approach would help to predict AF recurrence before the initiation of rhythmcontrol therapies in patients.

Combined assessment of left atrial volume parameters for predicting recurrence of atrial fibrillation following pulmonary vein isolation in patients with paroxysmal atrial fibrillation

“…LA volume in patients with AF recurrence was smaller than that in patients without AF recurrence, and LAEF was also lower in patients with AF recurrence,35,37 however, Chin et al38 showed the opposite result as our study. Their LAVI of study population was much larger compared to Chin et al's and our study so that this discrepancy may depend on LAVI of study population.…”

Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta‐analysis

“…After excluding 652 studies, the remaining 161 full‐text articles were considered (7 from reference list search) against the inclusion and exclusion criteria. After careful assessment, 76 of the 161 articles were further excluded according to the eligibility criteria (Table S1) leaving the remaining 85 articles to be included in the analysis (Al Chekakie et al ., ; Arya et al ., ; Aytemir et al ., , ; Bertaglia et al ., ; Bhargava et al ., ; Canpolat et al ., , ; Cao et al ., ; Chao et al ., , ; Clementy et al ., ; Combes et al ., ; De Potter et al ., ; Di Donna et al ., ; Efremidis et al ., ; Ejima et al ., , ; Evranos et al ., ; Fukushima et al ., ; Gertz et al ., ; Hammerstingl et al ., ; Hu et al ., ; Husser et al ., ; Hwang et al ., ; Im et al ., ; Ishikawa et al ., ; Kawakami et al ., ; Kawasaki et al ., ; Kim et al ., , ; Kızılırmak et al ., ; Kocyigit et al ., ; Kohári et al ., ; Komatsu et al ., ; Kosiuk et al ., ; Kuppahally et al ., ; Kurotobi et al ., ; Letsas et al ., ; Lim et al ., ; Lin et al ., , , ; Liu et al ., ; Ma et al ., ; Machino‐Ohtsuka et al ., ; Matsuo et al ., ; McCready et al ., ; Mirza et al ., ; Miyazaki et al ., , ; Montserrat et al ., ; Moon et al ., ; Morris et al ., ; Motoki et al ., ; Nakazawa et al ., ; Naruse et al ., , ; Pappone et al ., ; Parwani et al .,…”

Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study)

“…Further insight in the significance of echo‐derived parameters of LA and ventricular function is expected from the ongoing “EACVI AFib Echo Europe Registry,” which aims to correlate such indices with thromboembolic risk in patients with AFib . Moreover, LAEF has been associated with AFib ablation outcomes and baseline LAEF has been reported to independently predict LAEF improvement or AFib recurrences after RF ablation.…”