Journal of cardiovascular medicine | 2021
Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablation.
Abstract
AIMS\nTo quantitatively investigate the impact of left atrial geometric remodeling on atrial fibrillation recurrence after catheter ablation.\n\n\nMETHODS\nA retrospective analysis of 105 patients with atrial fibrillation who underwent coronary computed tomographic angiography before catheter ablation. Risk factors for atrial fibrillation recurrence were identified by multivariable logistic regression analysis and used to create a nomogram.\n\n\nRESULTS\nAfter at least 12\u200amonths of follow-up, 30 patients (29%) developed recurrent atrial fibrillation. Patients with recurrence had higher left atrial volume, left atrial sphericity, and lower left atrial ejection fraction (LAEF) (P\u200a<\u200a0.05). There was no significant difference in asymmetry index between the two groups (P\u200a=\u200a0.121). Multivariable regression analysis showed that left atrial minimal volume index (LAVImin) [odds ratio (OR): 1.026, 95% confidence interval (CI): 1.002-1.050, P\u200a=\u200a0.034], left atrial sphericity (OR: 1.222, 95% CI: 1.040-1.435, P\u200a=\u200a0.015) and CHADS2 score (OR: 1.511, 95% CI: 1.024-2.229, P\u200a=\u200a0.038) were independent predictors of atrial fibrillation recurrence. The combined model of the left atrial sphericity to the LAVImin substantially increased the predictive power for atrial fibrillation recurrence [area under the curve (AUC)\u200a=\u200a0.736, 95% CI: 0.627-0.844, P\u200a<\u200a0.001], with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.772 (95% CI: 0.670-0.875) and had good internal validity.\n\n\nCONCLUSION\nThe CHADS2 score, left atrial sphericity, and LAVImin were significant and independent predictors of atrial fibrillation recurrence after catheter ablation. Furthermore, the nomogram had a better predictive capacity for atrial fibrillation recurrence.