Conventional versus 3‐D Echocardiography to Predict Arrhythmia Recurrence After Atrial Fibrillation Ablation
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Echocardiography to Predict AF RecurrenceBackgroundArrhythmia recurrence after atrial fibrillation (AF) ablation remains high and requires repeat interventions in a substantial number of patients. We assessed the value of conventional and 3‐D echocardiography to predict AF recurrence.Methods and ResultsConsecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Echocardiograms were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including 3‐D left atrial (LA) volumetry and determination of LA function and sphericity. The primary endpoint, AF recurrence (>30 seconds) between 3 to 12 months after AF ablation, was independently adjudicated. We included 276 patients (73% male, mean age 59.9 ± 9.9 years). Paroxysmal and persistent AF were present in 178 (64%) and 98 (36%) patients, respectively. Mean left ventricular ejection fraction and indexed LA volume in 3‐D (LAVI) were 52 ± 12% and 42 ± 13 mL/m2, respectively. AF recurrence was observed in 110 (40%) patients after a single procedure. Median (interquartile range) time to AF recurrence was 123 (92; 236) days. In multivariable Cox regression models, the only predictors for AF recurrence were the minimal, maximal, and indexed 3‐D LA volumes, P = 0.024, P = 0.016, and P = 0.014, respectively. Quartile specific analysis of 3‐D LAVI showed an HR of 1.885 (95%CI 1.066–3.334; P for trend = 0.015) for the highest compared to the lowest quartile.ConclusionOur results show the important role of LA volume for the long‐term freedom from arrhythmia after AF ablation. These data also highlight the potential of 3‐D echocardiography in this context and may facilitate patient selection for AF ablation.
