Association of Left Atrial Function Index With Late Atrial Fibrillation Recurrence after Catheter Ablation

Abstract

Introduction Although catheter ablation (CA) for atrial fibrillation (AF) is commonly used to improve symptoms, AF recurrence is common and new tools are needed to better inform patient selection for CA. Left Atrial Function Index (LAFI), an echocardiographic measure of atrial mechanical function, has shown promise as a non-invasive predictor of AF. We hypothesized that LAFI would relate to AF recurrence after CA. Methods and Results All AF patients undergoing index CA were enrolled in a prospective institutional AF Treatment Registry between 2011 and 2014. LAFI was measured post-hoc from pre-ablation clinical echocardiographic images in 168 participants. Participants were mostly male (33% female), middle-aged (60±10 years), obese and had paroxysmal AF (64%). Mean LAFI was 25.9±17.6. Over 12 months of follow-up, 78 participants (46%) experienced a late AF recurrence. In logistic regression analyses adjusting for factors known to be associated with AF, lower LAFI remained associated with AF recurrence after CA [OR 0.04 (0.01 – 0.67), p= 0.02]. LAFI discriminated AF recurrence after CA slightly better than CHADS2 (C-statistic 0.60 LAFI, 0.57 CHADS2). For participants with persistent AF, LAFI performed significantly better than CHADS2 score (C statistic= 0.79 LAFI, 0.56 CHADS2, p= 0.02). Conclusion LAFI, an echocardiographic measure of atrial function, is associated with AF recurrence after CA and has improved ability to discriminate AF recurrence as compared to the CHADS-2 score, especially among persistent AF patients. Since LAFI can be calculated using standard two-dimensional echocardiographic images, it may be a helpful tool for predicting AF recurrence.

Relations between plasma microRNAs, echocardiographic markers of atrial remodeling, and atrial fibrillation: Data from the Framingham Offspring study

“…Experimental studies have shown that exposure to cardiovascular risk factors influences LA gene expression, pathological cardiac remodeling, and AF [10]. Recently, we demonstrated that plasma microRNAs related strongly to AF as well as recurrence of AF after catheter ablation [11,12]. In the present study, we employed a mechanism-based framework to identify promising candidate plasma microRNAs and then explored associations of those microRNAs with incident and prevalent AF in a community-based cohort.…”

Association of Left Atrial Function Index with Atrial Fibrillation and Cardiovascular Disease: The Framingham Offspring Study

“…LAFI can be derived using LA and LV measures obtained routinely as part of standard 2‐dimensional echocardiography . Recent data suggest that LAFI is strongly associated with risk for developing AF recurrence, heart failure, and stroke in select CVD‐based samples . We recently reported on the distribution of LAFI as well as its clinical and echocardiographic correlates in the community‐based FHS (Framingham Heart Study) Offspring Cohort .…”

“…21 Recent data suggest that LAFI is strongly associated with risk for developing AF recurrence, heart failure, and stroke in select CVD-based samples. [22][23][24][25] We recently reported on the distribution of LAFI as well as its clinical and echocardiographic correlates in the community-based FHS (Framingham Heart Study) Offspring Cohort. 26 In the current investigation, we related LAFI to incident AF and CVD in FHS Offspring participants and assessed its incremental contribution to prediction of these outcomes.…”

Clinical and Echocardiographic Correlates of Left Atrial Function Index: The Framingham Offspring Study

“…In select populations with CVD, a lower LAFI is associated with an increased risk of incident heart failure, cerebrovascular events, atrial fibrillation recurrence, and all-cause mortality. 16–19 In this retrospective investigation, we describe the distribution of LAFI and the cross-sectional clinical and echocardiographic correlates of LAFI in a community-based sample.…”