Skip to main content
SpringerLink
Log in

Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation

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

Abstract

Purpose

Left atrium (LA) size is a common predictor of ablation outcomes in atrial fibrillation (AF), but different LA diameters have not been adequately studied yet. We aimed to find the best predictor of ablation outcomes using single-linear LA dimensions by computed tomography (CT) or echocardiography.

Methods

Patients (n = 103, 72 males, 59 ± 9 years) undergoing AF ablation were analyzed. LA diameter (LA-D) was measured by transthoracic echocardiography (parasternal long axis). After 3D reconstruction of CT data (EnSite Verismo, SJM, MN), maximal LA dimensions were measured on a coronal plane (superior-inferior, SI, and transversal, TV) and a sagittal plane (anterior-posterior, AP). Volume (LAV) was rendered after LA appendage and pulmonary vein exclusion.

Results

Patients with persistent AF (n = 40) had significantly larger LA size than those with paroxysmal AF (n = 63). After 26 ± 14 months, 31 (30 %) patients had AF recurrence. Univariate Cox regression analysis revealed that LA-D, LA-SI, LA-TV, LAV, and LAV-index (LAV/body surface area) were associated with AF recurrence. Multivariate Cox regression analysis revealed that LAV was the strongest independent predictor of AF recurrence (HR = 1.011 per ml, 95 % CI 1.003–1.020, p = 0.002). LA-TV had the best correlation with LAV (r = 0.69, p < 0.01) and was the strongest single-linear predictor (HR = 1.07 per mm, 95 % CI 1.022–1.121, p = 0.004). Independent of LA-D, an LA-TV>74.5 mm predicted AF recurrence similarly to LAV>126 ml.

Conclusions

LA dilatation, especially on the coronal plane, is associated with reduced long-term success after catheter ablation. LA-TV is the best linear predictor of AF recurrence, stronger than the commonly used LA-D.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tsang, M. Y., Barnes, M. E., & Tsang, T. S. (2012). Left atrial volume: clinical value revisited. Current Cardiology Reports, 14(3), 374–380.

    Article  PubMed  Google Scholar 

  2. Berruezo, A., Tamborero, D., Mont, L., Benito, B., Tolosana, J. M., Sitges, M., et al. (2007). Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. European Heart Journal, 28(7), 836–841.

    Article  PubMed  Google Scholar 

  3. Shin, S. H., Park, M. Y., Oh, W. J., Hong, S. J., Pak, H. N., Song, W. H., et al. (2008). Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation. Journal of the American Society of Echocardiography, 21(6), 697–702.

    Article  PubMed  Google Scholar 

  4. Abecasis, J., Dourado, R., Ferreira, A., Saraiva, C., Cavaco, D., Santos, K. R., et al. (2009). Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace, 11(10), 1289–1294.

    Article  PubMed  Google Scholar 

  5. Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., et al. (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. European Heart Journal, 33(21), 2719–2747.

    Article  PubMed  Google Scholar 

  6. Badano, L. P., Pezzutto, N., Marinigh, R., Cinello, M., Nucifora, G., Pavoni, D., et al. (2008). How many patients would be misclassified using M-mode and two-dimensional estimates of left atrial size instead of left atrial volume? A three-dimensional echocardiographic study. Journal of Cardiovascular Medicine (Hagerstown, Md.), 9(5), 476–484.

    Article  Google Scholar 

  7. Nedios, S., Tang, M., Roser, M., Solowjowa, N., Gerds-Li, J. H., Fleck, E., et al. (2011). Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation: predictive value after ablative treatment. Journal of Interventional Cardiac Electrophysiology, 32(2), 87–94.

    Article  PubMed  Google Scholar 

  8. Sohns, C., Sohns, J. M., Vollmann, D., Luthje, L., Bergau, L., Dorenkamp, M., et al. (2013). Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation. European Heart Journal – Cardiovascular Imaging, 14(7), 684–691.

    Article  PubMed  Google Scholar 

  9. Bisbal, F., Guiu, E., Calvo, N., Marin, D., Berruezo, A., Arbelo, E., et al. (2013). Left atrial sphericity: a new method to assess atrial remodeling. Impact on the outcome of atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 24(7), 752–759.

    Article  PubMed  Google Scholar 

  10. Tsang, T. S., Abhayaratna, W. P., Barnes, M. E., Miyasaka, Y., Gersh, B. J., Bailey, K. R., et al. (2006). Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? Journal of the American College of Cardiology, 47(5), 1018–1023.

    Article  PubMed  Google Scholar 

  11. Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., et al. (2006). Recommendations for chamber quantification. European Journal of Echocardiography, 7(2), 79–108.

    Article  PubMed  Google Scholar 

  12. Mosteller, R. D. (1987). Simplified calculation of body-surface area. The New England Journal of Medicine, 317(17), 1098.

    CAS  PubMed  Google Scholar 

  13. Eitel, C., Hindricks, G., Sommer, P., Gaspar, T., Kircher, S., Wetzel, U., et al. (2010). Circumferential pulmonary vein isolation and linear left atrial ablation as a single-catheter technique to achieve bidirectional conduction block: the pace-and-ablate approach. Heart Rhythm, 7(2), 157–164.

    Article  PubMed  Google Scholar 

  14. Hoffmeister, P. S., Chaudhry, G. M., Mendel, J., Almasry, I., Tahir, S., Marchese, T., et al. (2007). Evaluation of left atrial and posterior mediastinal anatomy by multidetector helical computed tomography imaging: relevance to ablation. Journal of Interventional Cardiac Electrophysiology, 18(3), 217–223.

    Article  PubMed  Google Scholar 

  15. Sanfilippo, A. J., Abascal, V. M., Sheehan, M., Oertel, L. B., Harrigan, P., Hughes, R. A., et al. (1990). Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation, 82(3), 792–797.

    Article  CAS  PubMed  Google Scholar 

  16. Vandenberg, B. F., Weiss, R. M., Kinzey, J., Acker, M., Stark, C. A., Stanford, W., et al. (1995). Comparison of left atrial volume by two-dimensional echocardiography and cine-computed tomography. The American Journal of Cardiology, 75(10), 754–757.

    Article  CAS  PubMed  Google Scholar 

  17. Helms, A. S., West, J. J., Patel, A., Lipinski, M. J., Mangrum, J. M., Mounsey, J. P., et al. (2009). Relation of left atrial volume from three-dimensional computed tomography to atrial fibrillation recurrence following ablation. The American Journal of Cardiology, 103(7), 989–993.

    Article  PubMed  Google Scholar 

  18. Montefusco, A., Biasco, L., Blandino, A., Cristoforetti, Y., Scaglione, M., Caponi, D., et al. (2010). Left atrial volume at MRI is the main determinant of outcome after pulmonary vein isolation plus linear lesion ablation for paroxysmal-persistent atrial fibrillation. Journal of Cardiovascular Medicine (Hagerstown, Md.), 11(8), 593–598.

    Article  Google Scholar 

  19. Hauser, T. H., McClennen, S., Katsimaglis, G., Josephson, M. E., Manning, W. J., & Yeon, S. B. (2004). Assessment of left atrial volume by contrast enhanced magnetic resonance angiography. Journal of Cardiovascular Magnetic Resonance, 6(2), 491–497.

    Article  PubMed  Google Scholar 

  20. Hof, I., Arbab-Zadeh, A., Scherr, D., Chilukuri, K., Dalal, D., Abraham, T., et al. (2009). Correlation of left atrial diameter by echocardiography and left atrial volume by computed tomography. Journal of Cardiovascular Electrophysiology, 20(2), 159–163.

    Article  PubMed  Google Scholar 

  21. Parikh, S. S., Jons, C., McNitt, S., Daubert, J. P., Schwarz, K. Q., & Hall, B. (2010). Predictive capability of left atrial size measured by CT, TEE, and TTE for recurrence of atrial fibrillation following radiofrequency catheter ablation. Pacing and Clinical Electrophysiology, 33(5), 532–540.

    Article  PubMed  Google Scholar 

  22. Shin, S. Y., Yong, H. S., Na, J. O., Choi, C. U., Kim, S. H., Kim, J. W., et al. (2012). A simplified method to determine left atrial volume and transport function using multi-slice computed tomography in patients with atrial fibrillation: comparison with transthoracic echocardiography. The International Journal of Cardiovascular Imaging, 28(5), 1205–1216.

    Article  PubMed  Google Scholar 

  23. von Bary, C., Dornia, C., Eissnert, C., Nedios, S., Roser, M., Hamer, O. W., et al. (2012). Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 34(2), 181–188.

    Article  Google Scholar 

  24. den Uijl, D. W., Tops, L. F., Delgado, V., Schuijf, J. D., Kroft, L. J., de Roos, A., et al. (2011). Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. The American Journal of Cardiology, 107(2), 243–249.

    Article  Google Scholar 

  25. Avelar, E., Durst, R., Rosito, G. A., Thangaroopan, M., Kumar, S., Tournoux, F., et al. (2010). Comparison of the accuracy of multidetector computed tomography versus two-dimensional echocardiography to measure left atrial volume. The American Journal of Cardiology, 106(1), 104–109.

    Article  PubMed  Google Scholar 

  26. Al-Mohaissen, M. A., Kazmi, M. H., Chan, K. L., & Chow, B. J. (2013). Validation of two-dimensional methods for left atrial volume measurement: a comparison of echocardiography with cardiac computed tomography. Echocardiography, 30(10), 1135–1142.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. Hedi Razavi, Ph.D., for her valuable editorial assistance.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    Sotirios Nedios, Jedrzej Kosiuk, Emmanuel Koutalas, Jelena Kornej, Philipp Sommer, Arash Arya, Sergio Richter, Sascha Rolf, Daniela Husser, Gerhard Hindricks & Andreas Bollmann

Authors
  1. Sotirios Nedios
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jedrzej Kosiuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emmanuel Koutalas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jelena Kornej
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philipp Sommer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arash Arya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sergio Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sascha Rolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniela Husser
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gerhard Hindricks
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Andreas Bollmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sotirios Nedios.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nedios, S., Kosiuk, J., Koutalas, E. et al. Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 43, 237–244 (2015). https://doi.org/10.1007/s10840-015-0010-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-015-0010-8

Keywords

Search

Navigation