Anteroposterior Diameter of the Left Atrium Determines the Occurrence of Left Atrial Tachycardia in Non-paroxysmal Atrial Fibrillation Patients after Catheter Ablation
Abstract
Objectives:
The relationship between left atrial (LA) size and atrial fibrillation (AF) is well-established. However, the specifics of LA regional remodeling and its connection to left atrial tachycardia (LA-AT) post-ablation in patients with non-paroxysmal AF are less understood. This study aims to explore how LA dimensions are related to the development of LA-AT following AF ablation procedures in these patients.
Methods:
This study focused on 73 patients with non-paroxysmal atrial fibrillation (average age 52, predominantly male, with a nearly even split between persistent and long-lasting persistent AF), all undergoing their first catheter ablation for AF. Prior to the ablation, left atrial dimensions were determined through computed tomography, measuring the maximal transverse, anteroposterior, and superoinferior diameters.
Results:
Over an average follow-up period of 23 months, 31.5% of the patients (Group 1) experienced left atrial tachycardia (LA-AT) that required a second linear ablation procedure. This group had significantly larger left atrial (LA) dimensions in terms of transverse, anteroposterior, and superoinferior measurements compared to the other group (Group 2). However, the recurrence of atrial fibrillation (AF) was not linked to any specific LA diameter. The anteroposterior diameter was identified as a significant predictor (p=0.002, HR 2.3, 95% CI 1.3-3.8) for LA-AT occurrence through multivariate analysis.
Conclusions:
Eccentric dilatation involving the anteroposterior diameter is a significant predictor for the occurrence of LA-AT in patients with non-paroxysmal AF after catheter ablation.
Keywords
Atrial fibrillation; Atrial flutter; Atrial tachycardia; Left atrial diameter; Catheter ablation; Computed tomography
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References
2. Roney CH, Sim I, Yu J, Beach M, Mehta A, Alonso Solis-Lemus J, et al. Predicting Atrial Fibrillation Recurrence by Combining Population Data and Virtual Cohorts of Patient-Specific Left Atrial Models. Circ Arrhythm Electrophysiol. 2022 Feb;15(2).
3. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024 Jan 2;149(1).
4. CHANG S, LIN Y, TAI C, LO L, TUAN T, UDYAVAR AR, et al. Induced Atrial Tachycardia After Circumferential Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation: Electrophysiological Characteristics and Impact of Catheter Ablation on the Follow‐Up Results. J Cardiovasc Electrophysiol. 2009 Apr 23;20(4):388–94.
5. Jaïs P, Hocini M, Hsu LF, Sanders P, Scavee C, Weerasooriya R, et al. Technique and Results of Linear Ablation at the Mitral Isthmus. Circulation. 2004 Nov 9;110(19):2996–3002.
6. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2019 Jan 1;32(1):1–64.
7. TSAO H, WU M, CHERN M, TAI C, LIN Y, CHANG S, et al. Anatomic Proximity of the Esophagus to the Coronary Sinus: Implication for Catheter Ablation Within the Coronary Sinus. J Cardiovasc Electrophysiol. 2006 Mar 30;17(3):266–9.
8. Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC, et al. Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Pulmonary Veins. Circulation [Internet]. 1999 Nov 2;100(18):1879–86. Available from: https://www.ahajournals.org/doi/10.1161/01.CIR.100.18.1879
9. LIN Y, TAI C, CHANG S, LO L, TUAN T, WONGCHAROEN W, et al. Efficacy of Additional Ablation of Complex Fractionated Atrial Electrograms for Catheter Ablation of Nonparoxysmal Atrial Fibrillation. J Cardiovasc Electrophysiol. 2009 Jun;20(6):607–15.
10. Cherian TS, Callans DJ. Recurrent Atrial Fibrillation After Radiofrequency Ablation. Card Electrophysiol Clin. 2020 Jun;12(2):187–97.
11. Efremidis M, Letsas KP, Georgopoulos S, Karamichalakis N, Vlachos K, Lioni L, et al. Safety, long-term outcomes and predictors of recurrence following a single catheter ablation procedure for atrial fibrillation. Acta Cardiol. 2019 Jul 4;74(4):319–24.
12. Demarchi A, Neumann L, Rordorf R, Conte G, Sanzo A, Özkartal T, et al. Long-term outcome of catheter ablation for atrial fibrillation in patients with severe left atrial enlargement and reduced left ventricular ejection fraction. EP Europace. 2021 Nov 8;23(11):1751–6.
13. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017 Oct 1;14(10):e275–444.
14. Pappone C, Manguso F, Vicedomini G, Gugliotta F, Santinelli O, Ferro A, et al. Prevention of Iatrogenic Atrial Tachycardia After Ablation of Atrial Fibrillation. Circulation. 2004 Nov 9;110(19):3036–42.
15. Voskoboinik A, Moskovitch JT, Harel N, Sanders P, Kistler PM, Kalman JM. Revisiting pulmonary vein isolation alone for persistent atrial fibrillation: A systematic review and meta-analysis. Heart Rhythm. 2017 May;14(5):661–7.
16. LO L, LIN Y, TSAO H, CHANG S, UDYAVAR AR, HU Y, et al. The Impact of Left Atrial Size on Long‐Term Outcome of Catheter Ablation of Chronic Atrial Fibrillation. J Cardiovasc Electrophysiol. 2009 Nov 30;20(11):1211–6.
17. Chugh A, Oral H, Lemola K, Hall B, Cheung P, Good E, et al. Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm. 2005 May;2(5):464–71.
18. Vlachos K, Efremidis M, Derval N, Martin CA, Takigawa M, Bazoukis G, et al. Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation. EP Europace. 2021 Jul 18;23(7):1052–62.
19. DAOUD EG, WEISS R, AUGOSTINI R, HUMMEL JD, KALBFLEISCH SJ, VAN DEREN JM, et al. Proarrhythmia of Circumferential Left Atrial Lesions for Management of Atrial Fibrillation. J Cardiovasc Electrophysiol. 2006 Feb 23;17(2):157–65.
20. Gucuk Ipek E, Marine J, Yang E, Habibi M, Chrispin J, Spragg D, et al. Predictors and Incidence of Atrial Flutter After Catheter Ablation of Atrial Fibrillation. Am J Cardiol. 2019 Dec;124(11):1690–6.
21. Garvanski I, Simova I, Angelkov L, Matveev M. Predictors of Recurrence of AF in Patients After Radiofrequency Ablation. European Cardiology Review. 2019 Dec 18;14(3):165–8.
22. Mujović N, Marinković M, Marković N, Vučićević V, Lip GYH, Bunch TJ, et al. The relationship of early recurrence of atrial fibrillation and the 3-month integrity of the ablation lesion set. Sci Rep. 2018 Jun 29;8(1):9875.
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