Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation

Abstract

Introduction Catheter ablation is an established therapy for rhythm\ncontrol in patients with drug-refractory atrial fibrillation (AF),\nhowever, recurrence is frequent particularly in persistent AF. There are\nno consistently confirmed predictors of AF recurrence after catheter\nablation. Therefore, we aimed to study whether LAA volume (LAAV) and\nfunction influence the long-term recurrence of AF after catheter\nablation, depending on AF type. Methods AF patients who underwent\npoint-by-point radiofrequency catheter ablation after cardiac computed\ntomography (CT) were included in this analysis. LAAV and LAA orifice\narea were measured by CT. Uni- and multivariable Cox proportional hazard\nregression models were performed to determine the predictors of AF\nrecurrence. Results In total, 561 AF patients (61.9\uf0b110.2 years, 34.9%\nfemales) were included in the study. Recurrence of AF was detected in\n40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in\nthose with persistent AF) with a median recurrence-free time of 22.7\n\uf05b9.3-43.1\uf05d months. Patients with persistent AF had significantly higher\niLAV, LAAV, LAA orifice area and lower LAA flow velocity, than those\nwith paroxysmal AF. After adjustment left ventricular ejection fraction\n(LVEF) <50% (HR=2.17; 95%CI=1.38-3.43; p<0.001)\nand LAAV (HR=1.06; 95%CI=1.01-1.12; p=0.029) were independently\nassociated with AF recurrence in persistent AF, while no independent\npredictors could be identified in paroxysmal AF. Conclusion The current\nstudy demonstrates that beyond left ventricular systolic dysfunction,\nLAA enlargement is associated with higher rate of AF recurrence after\ncatheter ablation in persistent AF, but not in patients with paroxysmal\nAF.