Right atrial diameter and outcome of catheter ablation of atrial fibrillation
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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).
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.
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.
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.
KeywordsAtrial fibrillation Catheter ablation Recurrence Left atrium Right atrium
Left atrial appendage
Left atrium diameter
Left ventricular end-diastolic dimension
Left ventricular end-systolic dimension
Left ventricular ejection fraction
Right atrial diameter
Pulmonary vein isolation
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 for the AF ablation procedure was obtained from each patient.
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.
Part of results of this study has been accepted for an abstract presentation in 2016 Annual Session of European Society of Cardiology (Rome, Italy).
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