Biatrial volume ratio predicts low voltage areas in atrial fibrillation |
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Authors: | Timm Seewö ster,Borislav Dinov,Sotirios Nedios,Gerhard Hindricks,Philipp Sommer,Jelena Kornej |
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Affiliation: | 1. Department of Electrophysiology, Heart Center Leipzig – University Hospital of Cardiology, Leipzig Germany ; 2. Department of Electrophysiology, Herz‐ und Diabeteszentrum NRW, Bad Oeynhausen Germany ; 3. School of Medicine – Cardiovascular Medicine, Boston University, Boston Massachusetts, USA |
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Abstract: | BackgroundLeft atrial volume (LAV) and low voltage areas (LVAs) are acknowledged markers for worse rhythm outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients.ObjectiveTo investigate association between the LAV/RAV ratio and LVAs presence.MethodsPatients undergoing first AF ablation were included. LVAs were assessed peri‐procedurally using high‐density 3D maps and defined as <0.5 mV. All patients underwent pre‐procedural cardiovascular magnetic resonance imaging. LAV (biplane) and RAV (monoplane 4‐chamber) were assessed prior to ablation, and the LAV/RAV ratio was calculated.ResultsThe study population included 189 patients (age mean 63 ± 10 years, 33% women, 57% persistent AF, 22% LVAs). There were 149 (79%) patients with LAV > RAV. In univariable analysis LAV > RAV was associated with LVAs (OR 6.803, 95%CI 1.395–26.514, p = .016). The association remained robust in multivariable model after adjustment for persistent AF, CHA2DS2‐VASc score, and heart rate (OR 5.981, 95%CI 1.256–28.484, p = .025). Using receiver operator curve analysis, LAV > RAV (AUC 0.668, 95%CI 0.585–0.751, p = .001) was significant predictor for LVAs. In multivariable analysis, after adjustment for age, persistent AF, and renal function, RAV≥LAV was threefold higher in males (OR 3.040, 95%CI 1.050–8.802, p = .04).ConclusionsLAV > RAV is useful for the prediction of electro‐anatomical substrate in AF. LAV > RAV was associated with LVAs presence, while male sex remained associated with RAV≥LAV and less LVAs. |
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Keywords: | atrial fibrillation cardiac magnetic resonance left atrial size low voltage areas right atrial volume |
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