Author + information
- Felipe Bisbal,
- Esther Guiu,
- Pilar Cabanas,
- Naiara Calvo,
- Antonio Berruezo,
- Elena Arbelo,
- Barbara Vidal,
- Teresa M. Caralt,
- Jose M. Tolosana,
- Josep Brugada and
- Lluis Mont
Pulmonary vein isolation (PVI) induces left atrial (LA) volume reduction, so-called reverse remodelling (RR). However, the related changes in LA geometry have not yet been evaluated. LA sphericity is a marker of atrial remodelling in patients with atrial fibrillation (AF) and is a powerful predictor of PVI success. The aim of the study was to evaluate the effect of PVI on LA sphericity and describe the spherical RR process.
Consecutive patients who underwent cardiac magnetic resonance before and 6 months after PVI were included. A 3D-reconstruction of LA excluding pulmonary veins and the LA appendage was used to define the LA cavity. The LA sphericity and volume was automatically obtained with self-customized software. RR was defined as any improvement in LA sphericity (Spherical RR) or volume (Volumetric RR).
A series of 79 patients were included. Spherical RR was observed in 41.8% of patients. Patients with paroxysmal AF had higher probability to present spherical RR as compared to patients with persistent AF (75.2% vs 47.8%, p=0.011). Furthermore, patients with persistent AF showed significant post-procedural worsening of LA sphericity (81.9% vs 82.9%, p=0.018). Patients with no recurrence showed a trend toward a higher proportion of spherical RR compared to those with recurrence (45% vs 30%, respectively; P=ns), whereas no differences were observed in volumetric RR (61.1% vs. 61.9%, respectively; P=ns). At the multivariate analysis, paroxysmal AF was identified as the only independent predictor for spherical RR (OR 5.820 [1.757–19.280], p=0.004), while volumetric RR was independently predicted by pre-procedural LA volume (OR 1.062 [1.026–1.099], p=0.001).
PVI leads to spherical RR in a substantial proportion of patients, with higher proportion in patients with paroxysmal AF. The presence of paroxysmal AF independently predicts the occurrence of this phenomenon. PVI performed early in the course of disease might result in higher probability of RR.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: AF/SVT X
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1279-48
- 2013 American College of Cardiology Foundation