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. 2016 Dec;27(12):1411-1419.
doi: 10.1111/jce.13086. Epub 2016 Oct 7.

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

Mayank Sardana  1 , Adedotun A Ogunsua  1 , Matthew Spring  1 , Amir Shaikh  1 , Owusu Asamoah  1 , Glenn Stokken  1 , Clifford Browning  1 , Cynthia Ennis  1 , J Kevin Donahue  1 , Lawrence S Rosenthal  1 , Kevin C Floyd  1 , Gerard P Aurigemma  1 , Nisha I Parikh  2 , David D McManus  1
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Association of Left Atrial Function Index With Late Atrial Fibrillation Recurrence after Catheter Ablation

Mayank Sardana et al. J Cardiovasc Electrophysiol. 2016 Dec.

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 noninvasive 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 2D echocardiographic images, it may be a helpful tool for predicting AF recurrence.

Keywords: arrhythmia recurrence; atrial fibrillation; atrial remodeling; catheter ablation; left atrial function index.

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Figures

FIGURE 1
FIGURE 1
Calculation of left atrial function index. From top to bottom: measurement of left atrial end-systolic volume (V1) and end-diastolic volume (V2) in in apical 4 and 2 chamber views, tracing left ventricular outflow tract – velocity time integral (LVOT-VTI) in apical 5 chamber view, calculation of left atrial ejection fraction, calculation of left atrial end-systolic volume index, calculation of left atrial function index
FIGURE 2
FIGURE 2
Distribution of Left atrial function index by rhythm at the time of echocardiogram and recurrence.
FIGURE 3
FIGURE 3
Receiver Operator Characteristic curves for discrimination of late atrial fibrillation recurrence in all study participants. Solid line represents the performance of LAFI (Area under the curve 0.60) and dotted line represents the performance of CHADS2 score (Area under the curve 0.57). Diagonal line of reference is also displayed.
FIGURE 4
FIGURE 4
Receiver Operator Characteristic curves for discrimination of late atrial fibrillation recurrence in participants with persistent atrial fibrillation. Solid line represents the performance of LAFI (Area under the curve 0.79) and dotted line represents the performance of CHADS2 score (Area under the curve 0.56). Diagonal line of reference is also displayed.
See this image and copyright information in PMC

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