Circulation journal : official journal of the Japanese Circulation Society · 2013
Pre-procedural prediction of termination of persistent atrial fibrillation by catheter ablation as an indicator of reverse remodeling of the left atrium.
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Kumagai Koji, Sakamoto Tamotsu, Nakamura Keijiro, Hayano Mamoru, Yamashita Eiji, Oshima Shigeru
Аннотация
BACKGROUND: The pre-procedural prediction of atrial fibrillation (AF) termination by catheter ablation in patients with persistent AF has not been evaluated fully. The aim of this study was to evaluate the pre-procedural predictors of persistent AF termination by ablation associated with the possibility of reverse remodeling of the left atrium (LA).
METHODS AND RESULTS: Seventy consecutive patients (mean age, 62±8 years) with persistent or long-standing persistent AF underwent ablation. They were divided into 2 groups: those with AF terminated by ablation (n=14; group 1) and those with AF terminated by cardioversion after ablation (n=56; group 2). The left atrial appendage (LAA) contraction velocity determined on transesophageal echocardiography was significantly decreased in group 2 as compared to group 1 (P<0.001). Kaplan-Meier analysis showed that the group 1 patients had a higher AF-free survival rate than those in group 2 during 12±4.1 months of follow-up (P=0.048). The LA reverse remodeling ratio, given as the volume difference between before and 3 months after ablation in group 1, was significantly greater after ablation than that in group 2 (25.8±13% vs. 15.0±15%, P=0.015). Multivariate logistic regression analysis indicated that the LAA contraction velocity was an independent predictor of persistent AF termination by ablation (P=0.018).
CONCLUSIONS: The LAA contraction velocity was the only non-invasive pre-procedural predictor of persistent AF termination by ablation, indicating the possibility of reverse remodeling of the LA.
METHODS AND RESULTS: Seventy consecutive patients (mean age, 62±8 years) with persistent or long-standing persistent AF underwent ablation. They were divided into 2 groups: those with AF terminated by ablation (n=14; group 1) and those with AF terminated by cardioversion after ablation (n=56; group 2). The left atrial appendage (LAA) contraction velocity determined on transesophageal echocardiography was significantly decreased in group 2 as compared to group 1 (P<0.001). Kaplan-Meier analysis showed that the group 1 patients had a higher AF-free survival rate than those in group 2 during 12±4.1 months of follow-up (P=0.048). The LA reverse remodeling ratio, given as the volume difference between before and 3 months after ablation in group 1, was significantly greater after ablation than that in group 2 (25.8±13% vs. 15.0±15%, P=0.015). Multivariate logistic regression analysis indicated that the LAA contraction velocity was an independent predictor of persistent AF termination by ablation (P=0.018).
CONCLUSIONS: The LAA contraction velocity was the only non-invasive pre-procedural predictor of persistent AF termination by ablation, indicating the possibility of reverse remodeling of the LA.