Author + information
- Christina Luong,
- Kenneth Gin,
- Matthew Bennett,
- John Jue,
- Krishnan Ramanathan,
- Marion Barnes,
- Pamela Colley,
- Darby Thompson and
- Teresa S.M. Tsang
The incremental value of right atrial (RA) volume, compared with left atrial diameter (LAd), left atrial (LA) volume, and biatrial (BA) volume as a predictor for non-valvular atrial fibrillation (AF) recurrence following direct current cardioversion (DCCV) has not been evaluated. We sought to compare the predictive ability of baseline RA volume indexed to BSA (RAVI), LAd, LAVI, and BAVI for post DCCV AF recurrence at 6 months.
Pre-specified data was collected for patients enrolled into AF Clinic and the AF Registry. The first 73 patients undergoing DCCV since inception of the registry constituted the study cohort. Echocardiogram was performed pre-cardioversion. Maximal LAVI and RAVI were performed offline using 4 chamber single plane Simpson's method, averaged over 5 cycles. BAVI is the summation of LAVI and RAVI. ECG was performed at baseline, precardioversion, and at each clinic visit. ECG at 6 months was available for all patients.
Of the 73 patients who underwent DCCV, 36 (49%) had reverted to AF by 6 months. Mean age was 63 years (Q1 57, Q3 70), 50 (69%) were male, and 34 patients were ≥65 years (47%). A history of systemic hypertension, diabetes mellitus, heart failure, and transient ischemic attack/ stroke was identified in 49 (67%), 12 (16%), 15 (21%), and 6 (8%) patients, respectively. The overall performance for prediction of AF recurrence at 6 months was greatest for RAVI (area under the receiver operator characteristic curve [AUC]: RAVI 0.85, LAD 0.62, LAVI 0.69, and BAVI 0.78). For prediction of AF recurrence at 6 months, RAVI of ≥46mL/m2 was associated with 84% sensitivity and 75% specificity, with a positive predictive valve (PPV) of 78% and a negative predictive value (NPV) of 82%. LAVI ≥51mL/m2 provided a sensitivity of 89% and specificity of 44% respectively, with PPV of 62% and NPV of 80%. The overall accuracy of RAVI ≥46mL/m2 was 80% and for LAVI of ≥51mL/m2 was 67% for the prediction of AF recurrence.
While LAVI is a robust predictor of AF recurrence post DCCV, RAVI appeared to outperform LAVI in this cohort.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VII
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1236-39
- 2013 American College of Cardiology Foundation