The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study
<b>Background/Objectives</b>: Catheter ablation for atrial fibrillation (AF) is a well-established therapeutic approach for maintaining sinus rhythm, though its efficacy remains suboptimal in certain patients. The left atrium (LA) volume, commonly assessed through transthoracic echocardi...
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2024-12-01
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| author | Amaia Martínez León David Testa Alonso María Salgado Ruth Álvarez Velasco Minel Soroa Daniel Gracia Iglesias David Calvo |
| author_facet | Amaia Martínez León David Testa Alonso María Salgado Ruth Álvarez Velasco Minel Soroa Daniel Gracia Iglesias David Calvo |
| author_sort | Amaia Martínez León |
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| description | <b>Background/Objectives</b>: Catheter ablation for atrial fibrillation (AF) is a well-established therapeutic approach for maintaining sinus rhythm, though its efficacy remains suboptimal in certain patients. The left atrium (LA) volume, commonly assessed through transthoracic echocardiography (TTE), is a recognized predictor of AF recurrence after pulmonary vein isolation (PVI). However, the complex three-dimensional structure of the LA makes precise measurement challenging with traditional TTE techniques. Electroanatomic mapping (EAM) offers a more accurate evaluation of LA geometry and volume, which may enhance the prediction of ablation outcomes. <b>Methods</b>: This prospective study included 197 patients with AF who were referred for PVI to our center (Hospital Universitario Central de Asturias, Spain) between 2016 and 2020. All participants underwent pre-ablation TTE and EAM to assess the electric active volume (EAV) of the LA. Clinical follow-up included regular Holter monitoring and electrocardiograms to detect AF recurrences. <b>Results</b>: The mean age was 56.3 ± 9.67 years, and 34% had persistent AF. The mean LA volumes measured by TTE and the EAV by EAM were 62.86 ± 15.58 mL and 126.75 ± 43.35 mL, respectively, with a moderate positive correlation (r = 0.49, <i>p</i> < 0.001). AF recurrences were observed in 51.27% of patients over a 36 ± 15-month follow-up period. Cox regression analyses (univariate and multivariate), Kaplan–Meier curves and log-rank tests were used to illustrate freedom from atrial arrhythmia during follow-up. Both EAV by EAM and TTE volumes were significant predictors of AF recurrence in the univariate analysis (HR 1.002 [1.001–1.003], <i>p</i> = 0.033 and HR 1.001 [1.006–1.012], <i>p</i> < 0.01, respectively). Among clinical variables, persistent AF was significantly associated with a higher risk of recurrence (HR 1.17 [1.096–1.268], <i>p</i> = 0.02). <b>Conclusions</b>: EAV of the LA assessment by EAM demonstrates a significant correlation with TTE measurements and is a predictor of AF post-ablation recurrence. In patients selected for catheter ablation, EAV by EAM provides additional insights that could contribute to therapeutic decision-making and risk stratification of AF recurrences. |
| format | Article |
| id | doaj-art-c44ce9f0b9d44f9da40feb30966a6782 |
| institution | Kabale University |
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| publishDate | 2024-12-01 |
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| spelling | doaj-art-c44ce9f0b9d44f9da40feb30966a67822025-01-24T13:23:41ZengMDPI AGBiomedicines2227-90592024-12-01131710.3390/biomedicines13010007The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective StudyAmaia Martínez León0David Testa Alonso1María Salgado2Ruth Álvarez Velasco3Minel Soroa4Daniel Gracia Iglesias5David Calvo6Arrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, SpainArrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, SpainArrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, SpainArrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, SpainArrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, SpainArrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, SpainArrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, Spain<b>Background/Objectives</b>: Catheter ablation for atrial fibrillation (AF) is a well-established therapeutic approach for maintaining sinus rhythm, though its efficacy remains suboptimal in certain patients. The left atrium (LA) volume, commonly assessed through transthoracic echocardiography (TTE), is a recognized predictor of AF recurrence after pulmonary vein isolation (PVI). However, the complex three-dimensional structure of the LA makes precise measurement challenging with traditional TTE techniques. Electroanatomic mapping (EAM) offers a more accurate evaluation of LA geometry and volume, which may enhance the prediction of ablation outcomes. <b>Methods</b>: This prospective study included 197 patients with AF who were referred for PVI to our center (Hospital Universitario Central de Asturias, Spain) between 2016 and 2020. All participants underwent pre-ablation TTE and EAM to assess the electric active volume (EAV) of the LA. Clinical follow-up included regular Holter monitoring and electrocardiograms to detect AF recurrences. <b>Results</b>: The mean age was 56.3 ± 9.67 years, and 34% had persistent AF. The mean LA volumes measured by TTE and the EAV by EAM were 62.86 ± 15.58 mL and 126.75 ± 43.35 mL, respectively, with a moderate positive correlation (r = 0.49, <i>p</i> < 0.001). AF recurrences were observed in 51.27% of patients over a 36 ± 15-month follow-up period. Cox regression analyses (univariate and multivariate), Kaplan–Meier curves and log-rank tests were used to illustrate freedom from atrial arrhythmia during follow-up. Both EAV by EAM and TTE volumes were significant predictors of AF recurrence in the univariate analysis (HR 1.002 [1.001–1.003], <i>p</i> = 0.033 and HR 1.001 [1.006–1.012], <i>p</i> < 0.01, respectively). Among clinical variables, persistent AF was significantly associated with a higher risk of recurrence (HR 1.17 [1.096–1.268], <i>p</i> = 0.02). <b>Conclusions</b>: EAV of the LA assessment by EAM demonstrates a significant correlation with TTE measurements and is a predictor of AF post-ablation recurrence. In patients selected for catheter ablation, EAV by EAM provides additional insights that could contribute to therapeutic decision-making and risk stratification of AF recurrences.https://www.mdpi.com/2227-9059/13/1/7atrial fibrillationcatheter ablationechocardiographyelectroanatomic mapping |
| spellingShingle | Amaia Martínez León David Testa Alonso María Salgado Ruth Álvarez Velasco Minel Soroa Daniel Gracia Iglesias David Calvo The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study Biomedicines atrial fibrillation catheter ablation echocardiography electroanatomic mapping |
| title | The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study |
| title_full | The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study |
| title_fullStr | The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study |
| title_full_unstemmed | The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study |
| title_short | The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study |
| title_sort | electroanatomic volume of the left atrium as a determinant of recurrences in patients with atrial fibrillation after pulmonary vein isolation a prospective study |
| topic | atrial fibrillation catheter ablation echocardiography electroanatomic mapping |
| url | https://www.mdpi.com/2227-9059/13/1/7 |
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