The impact of left atrial size on long-term outcome of catheter ablation of chronic atrial fibrillation

Li Wei Lo, Yenn Jiang Lin, Hsuan Ming Tsao, Shih Lin Chang, Ameya R. Udyavar, Yu Feng Hu, Kwo Chang Ueng, Wen Chin Tsai, Ta Chun Tuan, Chien Jung Chang, Wei Hua Tang, Satoshi Higa, Ching Tai Tai, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

LA Diameter and AF Procedural Termination.Background: The left atrial (LA) size is an important predictor of atrial fibrillation (AF) procedural termination and the long-term outcome. We sought to evaluate the long-term outcome in regard to the LA size and procedural termination. Methods: Eighty-seven consecutive chronic AF patients (72 males, 53 ± 10 years) underwent 3D mapping (NavX) and ablation. A stepwise approach including circumferential pulmonary vein (PV) isolation, linear ablation, and continuous complex-fractionated electrogram (CFE) ablation (targeting fractionation intervals of < 50 ms). Electrical cardioversion was applied to those without any procedural termination. The freedom from AF was defined as the maintenance of sinus rhythm without the use of any class I or III antiarrhythmic drugs after the blanking period. Results: Among the 87 patients, all received a circumferential PV isolation, 93% a linear ablation, and 59% a continuous CFE ablation. Those with AF procedural termination (n = 30) had a better long-term outcome when compared with those without termination during a follow-up of 21 ± 12 months. Moreover, a Kaplan-Meier analysis showed that in those with an LA diameter of less than 45 mm (n = 49), the freedom from AF rate was higher when procedural termination was achieved (P = 0.004). On the contrary, the outcome was comparable in those with an LA diameter of ≥ 45 mm (n = 38), whether AF procedural termination occurred or not (P = 0.658). Conclusions: AF procedural termination was related to the long-term success during chronic AF ablation, especially in those with an LA diameter of less than 45 mm. The favorable effect of termination decreased when the LA diameter was ≥ 45 mm.

Original languageEnglish
Pages (from-to)1211-1216
Number of pages6
JournalJournal of cardiovascular electrophysiology
Volume20
Issue number11
DOIs
StatePublished - Nov 2009

Keywords

  • Ablation
  • Atrial fibrillation
  • Electroanatomical mapping
  • Left atrium
  • Procedural termination
  • Pulmonary vein isolation

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