Left Atrial Sphericity: A New Method to Assess Atrial Remodeling. Impact on the Outcome of Atrial Fibrillation Ablation

Authors

  • Felipe Bisbal M.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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    • The first two authors contributed equally to this work.

  • Esther Guiu B. Eng.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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    • The first two authors contributed equally to this work.

  • Naiara Calvo M.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • David Marin Ph.D.,

    1. Mathematics Department, Universitat Autònoma de Barcelona, Catalonia, Spain
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  • Antonio Berruezo M.D., Ph.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • Elena Arbelo M.D., Ph.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • José Ortiz-Pérez M.D., Ph.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • Teresa María de Caralt M.D., Ph.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • José María Tolosana M.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • Roger Borràs,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • Marta Sitges M.D., Ph.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • Josep Brugada M.D., Ph.D.,

    1. Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • LLUÍS MONT M.D., Ph.D.

    Corresponding author
    • Unitat de Fibril·lació Auricular (UFA), Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain, IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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  • This work was supported by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Madrid, Spain [Fondo Investigación Sanitaria PI1102003, REDSINCOR RD06/0003/008 and Red HERACLES RD06/0009] and by a grant from Hospital Clínic, Barcelona, Spain [Premi Fi de Residència “Emili Letang”].

  • Drs. Mont, Brugada, and Berruezo have received research grants, as well as honoraria for giving lectures, from St. Jude Medical (Ensite NaVx) and Biosense Webster (CARTO).

  • Other authors: No disclosures.

Address for correspondence: Lluis Mont, M.D., Servei de Cardiologia; Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Catalonia, Spain. Fax: +34-93-4513045; E-mail: lmont@clinic.ub.es

Left Atrial Sphericity Predicts AF Ablation Outcome

 Background

Atrial fibrillation (AF) ablation outcome is mainly determined by atrial remodeling that, nowadays, is only estimated through clinical presentation (persistent vs. paroxysmal) and left atrial (LA) dimension. The aim of the study was to stage the atrial remodeling process using the Left Atrial Sphericity (LASP) and determine whether this technique may help to predict AF ablation outcome.

Methods

Consecutive patients who underwent contrast-enhanced cardiac magnetic resonance angiography before AF ablation were included in the study. Three-dimensional reconstruction of LA excluding pulmonary veins and the LA appendage was used to define the LA cavity. The LASP was automatically obtained with self-customized software.

Results

106 patients were included and categorized in 3 groups (Gs): discoid-LA (G1), intermediate-LA (G2), and spherical-LA (G3). The G3 patients had larger LA anteroposterior diameter than G1 and G2 patients (47 ± 7 vs 43 ± 6 and 39 ± 5mm; P < 0.001), greater LA volume (90 ± 39 vs 86 ± 24 and 73 ± 20 mm; P = 0.012), and higher prevalence of persistent AF (75% vs 48% and 29%; P = 0.034) structural heart disease (75% vs 19% and 19%; P < 0.001), and AF recurrence at 12 months follow-up (58% vs 29% and 5%, P < 0.001). The LASP had linear correlation to predicted probability of recurrence. Multivariate analysis identified LASP (OR 1.320 [1.096–1.591], P = 0.004) and hypertension (OR 3.694 [1.282–10.645]; P = 0.016) as independent risk factors for arrhythmia recurrence.

Conclusion

Left Atrial Sphericity is a new independent predictor of recurrence after AF ablation and may be useful in selecting the best candidates for AF ablation.

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