Skip to main content

Advertisement

Log in

Right atrial diameter and outcome of catheter ablation of atrial fibrillation

  • MULTIMEDIA REPORT
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

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

References

  1. Braunwald E. Shattuck lecture-cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med. 1997;337:1360–9.

    Article  CAS  PubMed  Google Scholar 

  2. Sacco RL, Benjamin EJ, Broderick JP, Dyken M, Easton JD, Feinberg WM, et al. American Heart Association Prevention Conference. IV. Prevention and Rehabilitation of Stroke. Risk factors. Stroke. 1997;28:1507–17.

  3. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P; ESC Committee for Practice Guidelines-CPG; Document Reviewers (2012). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association. Europace, 14, 1385–1413.

  4. Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.

    Article  PubMed  Google Scholar 

  5. Moon J, Hong YJ, Shim J, Hwang HJ, Kim JY, Pak HN, et al. Right atrial anatomical remodeling affects early outcomes of nonvalvular atrial fibrillation after radiofrequency ablation. Circ J. 2012;76:860–7.

    Article  PubMed  Google Scholar 

  6. Luong C, Thompson DJ, Bennett M, Gin K, Jue J, Barnes ME, et al. Right atrial volume is superior to left atrial volume for prediction of atrial fibrillation recurrence after direct current cardioversion. Can J Cardiol. 2015;31:29–35.

    Article  PubMed  Google Scholar 

  7. Houltz B, Johansson B, Berglin E, Karlsson T, Edvardsson N, Wandt B. Left ventricular diastolic function and right atrial size are important rhythm outcome predictors after intraoperative ablation for atrial fibrillation. Echocardiography. 2010;27:961–8.

    Article  PubMed  Google Scholar 

  8. The consensus statements endorsed by the Beijing Task Force on echocardiography. [Standard techniques and normal value of echocardiography measurements in the Chinese population]. 1st ed. Beijing, Scientific and Technical Documentation Press; 2005.

  9. Dong JZ, Sang CH, Yu RH, Long DY, Tang RB, Jiang CX, et al. Prospective randomized comparison between a fixed ‘2C3L’ approach vs. stepwise approach for catheter ablation of persistent atrial fibrillation. Europace. 2015;17:1798–806.

    Article  PubMed  Google Scholar 

  10. Frick M, Frykman V, Jensen-Urstad M, Ostergren J, Rosenqvist M. Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation. Clin Cardiol. 2001;24:238–44.

    Article  CAS  PubMed  Google Scholar 

  11. Ausma J, Wijffels M, Thone F, Wouters L, Allessie M, Borgers M. Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat. Circulation. 1997;96:3157–63.

    Article  CAS  PubMed  Google Scholar 

  12. Guo Y, Lip GY, Apostolakis S. Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012;60:2263–70.

    Article  CAS  PubMed  Google Scholar 

  13. Schoonderwoerd BA, Ausma J, Crijns HJ, Van Veldhuisen DJ, Blaauw EH, Van Gelder IC. Atrial ultrastructural changes during experimental atrial tachycardia depend on high ventricular rate. J Cardiovasc Electrophysiol. 2004;15:1167–74.

    Article  PubMed  Google Scholar 

  14. Avitall B, Bi J, Mykytsey A, Chicos A. Atrial and ventricular fibrosis induced by atrial fibrillation: evidence to support early rhythm control. Heart Rhythm. 2008;5:839–45.

    Article  PubMed  Google Scholar 

  15. Li D, Fareh S, Leung TK, Nattel S. Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation. 1999;100:87–95.

    Article  CAS  PubMed  Google Scholar 

  16. Therkelsen SK, Groenning BA, Svendsen JH, Jensen GB. Atrial and ventricular volume and function evaluated by magnetic resonance imaging in patients with persistent atrial fibrillation before and after cardioversion. Am J Cardiol. 2006;97:1213–9.

    Article  PubMed  Google Scholar 

  17. de Groot NM, Houben RP, Smeets JL, Boersma E, Schotten U, Schalij MJ, et al. Electropathological substrate of longstanding persistent atrial fibrillation in patients with structural heart disease: epicardial breakthrough. Circulation. 2010;122:1674–82.

    Article  PubMed  Google Scholar 

  18. Allessie MA, de Groot NM, Houben RP, Schotten U, Boersma E, Smeets JL, et al. Electropathological substrate of long-standing persistent atrial fibrillation in patients with structural heart disease: longitudinal dissociation. Circ Arrhythm Electrophysiol. 2010;3:606–15.

    Article  PubMed  Google Scholar 

  19. Hsu J, Hanna P, Van Wagoner DR, Barnard J, Serre D, Chung MK, et al. Whole genome expression differences in human left and right atria ascertained by RNA sequencing. Circ Cardiovasc Genet. 2012;5:327–35.

    Article  CAS  PubMed  Google Scholar 

  20. Lin H, Dolmatova EV, Morley MP, Lunetta KL, McManus DD, Magnani JW, et al. Gene expression and genetic variation in human atria. Heart Rhythm. 2014;11:266–71.

    Article  PubMed  Google Scholar 

  21. Platonov PG, Mitrofanova LB, Orshanskaya V, Ho SY. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol. 2011;58:2225–32.

    Article  PubMed  Google Scholar 

  22. Maury P, Thomson E, Rollin A, Berry M, Cognet T, Duparc A, et al. Lack of correlations between electrophysiological and anatomical-mechanical atrial remodeling in patients with atrial fibrillation. Pacing Clin Electrophysiol. 2015;38:617–24.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

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.

Corresponding author

Correspondence to Chang-Sheng Ma.

Ethics declarations

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).

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wen, S.N., Liu, N., Bai, R. et al. Right atrial diameter and outcome of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 49, 157–164 (2017). https://doi.org/10.1007/s10840-017-0258-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-017-0258-2

Keywords

Navigation