Abstract 15869: Practical Clinical Risk Stratification for Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation- A Bayesian Approach
Pulmonary vein isolation (PVI) is the main step of interventional treatment of chronic left atrial (LA) fibrillation (AF). We tried to improve prediction of success in terms of persisting sinus rhythm (SR) after PVI (> 3 months).
Methods: In 139 consecutive patients undergoing PVI for treatment of AF ( 51 f , mean age 59±10 years) trans-thoracic echocardiograms were acquired by a Philips IE33 machine immediately prior to and at 3 and 6 and 12 months after PVI. Success was independently assessed from Holter- monitoring during follow-up. In addition to standard M-mode and Doppler parameters pulmonary vein velocities, end-diastolic (ED) LA-diameters and tissue Doppler mitral ring velocities were collected. LA fractional shortening (LA-FS) and a chamber stiffness index (CSI) was calculated (ED septal thickness/ ED diameter).
Results: AF recurrence (AF_R) occurred in 47/139 (34%) patients. Group differences concerning age or sex were not significant. Use of circumferential ablation (13% of cases) was associated with a higher frequency of AF_R as compared to use of alternative techniques (odds ratio (OR) 2.4 (1.4–5.0). Ostial ablation was performed in 62% of cases. Patients with A-wave at baseline had a significantly better prognosis (see figure). Residual LA function (LA-FS) allowed further risk stratification in these patients. In patients without A-wave the outcome depended on residual LA and diastolic left ventricular function ( iso- volumic relaxation time (IVRT) and CSI, see figure). Tissue or pulmonary vein Doppler did not add significant additional predictive value.
Conclusion: The presented model is an efficient and generally feasible risk assessment for recurrence of AF after PVI that uses only standard echocardiography data. It may be helpful in joint decision- making with the patient on therapy and may help to schedule follow-up.
- © 2010 by American Heart Association, Inc.