Left Atrial Sphericity: A New Method to Assess Atrial Remodeling. Impact on the Outcome of Atrial Fibrillation Ablation
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: firstname.lastname@example.org
Left Atrial Sphericity Predicts AF Ablation Outcome
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.
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.
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.
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.