Left atrial sphericity: A new method to assess atrial remodeling. impact on the outcome of atrial fibrillation ablation

Felipe Bisbal, Esther Guiu, Naiara Calvo, David Marin, Antonio Berruezo, Elena Arbelo, José Ortiz-Pérez, Teresa María De Caralt, José María Tolosana, Roger Borràs, Marta Sitges, Josep Brugada, Lluís Mont

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Abstract

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. © 2013 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)752-759
JournalJournal of Cardiovascular Electrophysiology
Volume24
DOIs
Publication statusPublished - 1 Jul 2013

Keywords

  • atrial fibrillation
  • cardiac magnetic resonance
  • catheter ablation
  • left atrial sphericity
  • remodeling

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    Bisbal, F., Guiu, E., Calvo, N., Marin, D., Berruezo, A., Arbelo, E., Ortiz-Pérez, J., De Caralt, T. M., Tolosana, J. M., Borràs, R., Sitges, M., Brugada, J., & Mont, L. (2013). Left atrial sphericity: A new method to assess atrial remodeling. impact on the outcome of atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 24, 752-759. https://doi.org/10.1111/jce.12116