Impact of atrial fibrillation phenotype and left atrial volume on outcome after pulmonary vein isolation
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology..
AIMS: Pulmonary vein isolation (PVI) is increasingly performed in patients with atrial fibrillation (AF). Both AF phenotype and left atrial (LA) volume have been shown to influence ablation outcome. The inter-relationship of the two is incompletely understood. We aimed to investigate the impact of AF phenotype vs. LA volume on outcome after PVI.
METHODS AND RESULTS: In a retrospective analysis of a prospective registry of patients undergoing a first PVI, the association of AF phenotype and LA volume index (LAVI) was assessed as well as their impact on AF recurrence during follow-up. Overall, 476 patients were enrolled (median age 63 years, 29% females, 65.8% paroxysmal AF). Obesity, hypertension, chronic kidney disease, and heart failure were all significantly more frequent in persistent AF. After 1 year, single-procedure, freedom from arrhythmia recurrence was 61.5%. Patients with paroxysmal AF had better outcomes compared with patients with persistent AF (65.6 vs. 52.7%, P = 0.003), as had patients with no/mild vs. moderate/severe LA dilation (LAVI <42 mL/m2 67.1% vs. LAVI ≥42 mL/m2 53%, P < 0.001). The combination of both parameters refined prediction of 1-year recurrence (P < 0.001). After adjustment for additional clinical risk factors in multivariable Cox proportional hazard analysis, both AF phenotype and LAVI ≥42 mL/m2 contributed significantly towards the prediction of 1-year recurrence.
CONCLUSION: Atrial fibrillation phenotype and LA volume are independent predictors of outcome after PVI. Persistent AF with no/mild LA dilation has a similar risk of recurrence as paroxysmal AF with a moderate/severe LA dilation and should be given similar priority for ablation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology - 26(2024), 4 vom: 30. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chollet, Laurève [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial fibrillation (AF) |
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| Anmerkungen: |
Date Completed 11.04.2024 Date Revised 12.04.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/europace/euae071 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370865464 |
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| 100 | 1 | |a Chollet, Laurève |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of atrial fibrillation phenotype and left atrial volume on outcome after pulmonary vein isolation |
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| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. | ||
| 520 | |a AIMS: Pulmonary vein isolation (PVI) is increasingly performed in patients with atrial fibrillation (AF). Both AF phenotype and left atrial (LA) volume have been shown to influence ablation outcome. The inter-relationship of the two is incompletely understood. We aimed to investigate the impact of AF phenotype vs. LA volume on outcome after PVI | ||
| 520 | |a METHODS AND RESULTS: In a retrospective analysis of a prospective registry of patients undergoing a first PVI, the association of AF phenotype and LA volume index (LAVI) was assessed as well as their impact on AF recurrence during follow-up. Overall, 476 patients were enrolled (median age 63 years, 29% females, 65.8% paroxysmal AF). Obesity, hypertension, chronic kidney disease, and heart failure were all significantly more frequent in persistent AF. After 1 year, single-procedure, freedom from arrhythmia recurrence was 61.5%. Patients with paroxysmal AF had better outcomes compared with patients with persistent AF (65.6 vs. 52.7%, P = 0.003), as had patients with no/mild vs. moderate/severe LA dilation (LAVI <42 mL/m2 67.1% vs. LAVI ≥42 mL/m2 53%, P < 0.001). The combination of both parameters refined prediction of 1-year recurrence (P < 0.001). After adjustment for additional clinical risk factors in multivariable Cox proportional hazard analysis, both AF phenotype and LAVI ≥42 mL/m2 contributed significantly towards the prediction of 1-year recurrence | ||
| 520 | |a CONCLUSION: Atrial fibrillation phenotype and LA volume are independent predictors of outcome after PVI. Persistent AF with no/mild LA dilation has a similar risk of recurrence as paroxysmal AF with a moderate/severe LA dilation and should be given similar priority for ablation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Atrial fibrillation (AF) | |
| 650 | 4 | |a Left atrial volume (LAV) | |
| 650 | 4 | |a Left atrial volume index (LAVI) | |
| 650 | 4 | |a Pulmonary vein isolation (PVI) | |
| 700 | 1 | |a Iqbal, Salik Ur Rehman |e verfasserin |4 aut | |
| 700 | 1 | |a Wittmer, Severin |e verfasserin |4 aut | |
| 700 | 1 | |a Thalmann, Gregor |e verfasserin |4 aut | |
| 700 | 1 | |a Madaffari, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Kozhuharov, Nikola |e verfasserin |4 aut | |
| 700 | 1 | |a Galuszka, Oskar |e verfasserin |4 aut | |
| 700 | 1 | |a Küffer, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Gräni, Christoph |e verfasserin |4 aut | |
| 700 | 1 | |a Brugger, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Servatius, Helge |e verfasserin |4 aut | |
| 700 | 1 | |a Noti, Fabian |e verfasserin |4 aut | |
| 700 | 1 | |a Haeberlin, Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Roten, Laurent |e verfasserin |4 aut | |
| 700 | 1 | |a Tanner, Hildegard |e verfasserin |4 aut | |
| 700 | 1 | |a Reichlin, Tobias |e verfasserin |4 aut | |
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