U-Shaped Relationship Between Left Atrium Size on Echocardiography and 1-Year Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation　- Prognostic Value Study.

ABSTRACT

BACKGROUND: The larger the left atrium anteroposterior dimension (LAD) and left atrium volume (LAV), the stronger the association with recurrent atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). Patients with a smaller left atrium (LA) size, however, also have increased AF recurrence.Methods and Results:In 521 patients, routine 48-h Holter electrocardiogram and echocardiography were obtained at each outpatient visit every 3 months for 12 months. On multivariate analysis, AF type, LAD, and LAV calculated using the ellipsoid model/body surface area (LAVe/BSA) were independent predictors of AF recurrence. Patients were divided into 7 groups at 0.4-cm increments of LAD ≤3 cm, LAD≤3 cm, 3.05.0 cm. Compared with the 3.4-3.8-cm group, the adjusted HR were 3.88 (95% CI 2.02-7.46, P<0.001), 1.03 (95% CI 0.50-2.12, P=0.939), 0.96 (95% CI 0.52-1.77, P=0.901), 1.36 (95% CI 0.72-2.57, P=0.347), 3.04 (95% CI 1.67-5.53, P<0.001), and 4.07 (95% CI 1.93-8.60, P<0.001), respectively. Similarly, we divided LAVe/BSA into 8 groups and also observed a U-shaped curve for AF recurrence.

CONCLUSIONS:

Both larger and smaller LAD and LAVe/BSA were associated with a higher risk of AF recurrence 1 year after RFCA. The association of LA size and AF recurrence after RFCA is represented by a U-shaped curve.