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Right atrial diameter and outcome of catheter ablation of atrial fibrillation

  • Song -Nan Wen
  • Nian Liu
  • Rong Bai
  • Ri-Bo Tang
  • Rong-Hui Yu
  • De-Yong Long
  • Cai-Hua Sang
  • Chen-Xi Jiang
  • Song-Nan Li
  • Jia-Hui Wu
  • Yan-Fei Ruan
  • Rong Hu
  • Xin Du
  • Xiao-Hui Liu
  • Jian-Zeng Dong
  • Chang-Sheng Ma
MULTIMEDIA REPORT

Abstract

Purpose

While AF is considered more like a left atrial (LA) disease, to what extent the right atrium contributes to the pathogenesis and ablation outcome of AF remains unclear. This study aimed to identify if right atrial diameter (RAD) could predict arrhythmia recurrence after catheter ablation of atrial fibrillation (AF).

Methods

Four hundred and seventy patients with drug-resistant AF [paroxysmal AF (PAF) 196; non-PAF 274] who underwent primary catheter ablation were enrolled. Ablation strategy included complete bilateral pulmonary vein isolation (PVI) in all patients and additional linear ablation across mitral isthmus, LA roof, and tricuspid isthmus in non-PAF cases. Risk factors associated with recurrence were determined by a Cox regression model, and the predictive power was evaluated by using receiver operating characteristic curve.

Results

After 24.3 ± 18.0 months, 284 patients (60.6%) experienced atrial tachyarrhythmia recurrence (111 in PAF, 173 in non-PAF). RAD was moderately associated with LA diameter (r = 0.371, P < 0.001), left ventricular ejection fraction (r = −0.205, P < 0.001), and left ventricular end-diastolic diameter (r = 0.319, P < 0.001). Multivariate Cox regression analysis demonstrated that RAD was an independent predictor for recurrence only in PAF patients with LAD ≥35 mm (HR 1.044, 95% CI 1.007–1.082, P = 0.021). The RAD cutoff value of 35.5 mm predicts atrial tachyarrhythmia recurrence with 85.4% sensitivity and 29.2% specificity. Kaplan-Meier analysis indicated that RAD over 35.5 mm is associated with more recurrence after PAF ablation (log-rank P = 0.034), comparing to those with RAD <35.5 mm.

Conclusions

RAD predicts outcome of ablation only in patients with PAF and concurrent LA enlargement. Under this condition, RAD <35.5 mm is associated with a more favorable recurrence-free survival at over 2-year follow-up.

Keywords

Atrial fibrillation Catheter ablation Recurrence Left atrium Right atrium 

Abbreviations

AADs

Antiarrhythmic drugs

AF

Atrial fibrillation

AT

Atrial tachycardia

ECG

Electrocardiography

LA

Left atrium

LAA

Left atrial appendage

LAD

Left atrium diameter

LVEDD

Left ventricular end-diastolic dimension

LVESD

Left ventricular end-systolic dimension

LVEF

Left ventricular ejection fraction

PAF

Paroxysmal AF

PV

Pulmonary vein

RA

Right atrium

RAD

Right atrial diameter

SR

Sinus rhythm

TEE

Transesophagic echocardiography

TTE

Transthoracic echocardiography

CS

Coronary sinus

PVI

Pulmonary vein isolation

CTI

Cavo-tricuspid isthmus

Notes

Authors’ contributions

Study was designed by Song-Nan Wen, Nian Liu, Rong Bai, and Chang-Sheng Ma. Data collection was done by Song-Nan Wen, Nian Liu, Ri-Bo Tang, Rong-Hui Yu, De-Yong Long, Cai-Hua Sang, Jia-Hui Wu, Chen-Xi Jiang, Yan-Fei Ruan, Song-Nan Li, Rong Hu, and Jian-Zeng Dong. Data were analyzed by Song-Nan Wen and Xin Du. Manuscript was prepared by Song-Nan Wen, Nian Liu, and Rong Bai. Critical revision to the manuscript was done by Rong Bai, Nian Liu, Xiao-Hui Liu, and Chang-Sheng Ma. All authors read and approved the manuscript.

Compliance with ethical standards

Informed consent

Informed consent for the AF ablation procedure was obtained from each patient.

Funding

This work was supported by the “National Natural Science Foundation of China” (81370290, 81500254), the “Excellent Talent of Beijing” (2015000021469G195), the “Beijing Natural Science Foundation” (7161003), and the “Capital Health Research and Development of Special” (2016-2-2062).

Conflict of interest

The authors declare that they have no conflict of interest.

Disclosures

Part of results of this study has been accepted for an abstract presentation in 2016 Annual Session of European Society of Cardiology (Rome, Italy).

Supplementary material

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Supplementary Table 1 (DOCX 20 kb)
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Supplementary Table 3 (DOCX 20 kb)
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Supplementary Table 4 (DOCX 20 kb)
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Supplementary Table 5 (DOCX 21 kb)
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Supplementary Table 6 (DOCX 20 kb)

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Song -Nan Wen
    • 1
  • Nian Liu
    • 1
  • Rong Bai
    • 1
  • Ri-Bo Tang
    • 1
  • Rong-Hui Yu
    • 1
  • De-Yong Long
    • 1
  • Cai-Hua Sang
    • 1
  • Chen-Xi Jiang
    • 1
  • Song-Nan Li
    • 1
  • Jia-Hui Wu
    • 1
  • Yan-Fei Ruan
    • 1
  • Rong Hu
    • 1
  • Xin Du
    • 1
  • Xiao-Hui Liu
    • 1
  • Jian-Zeng Dong
    • 1
  • Chang-Sheng Ma
    • 1
  1. 1.Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingPeople’s Republic of China

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