Abstract 18777: Prediction of Recurrent Atrial Fibrillation in Patients Treated by Pulmonary Vein Isolation
Introduction: Pulmonary vein isolation (PVI) has been established as effective interventional treatment in chronic atrial fibrillation (AF). Impairment of left atrial (LA) strain is considered a surrogate parameter of fibrosis. We hypothesized that minimal LA area, inter-segmental variance of LA strain and permanent AF (pAF) form a robust combination for predicting recurrent AF after PVI.
Methods: We evaluated 89 consecutive PVI patients (mean age 62 ± 11 y, 25 female). The longitudinal strain of the left atrium in a 4-chamber apical window was determined by speckle tracking (Philips IE33 offline analysis by QLAB™). Success was defined as maintenance of sinus rhythm until last follow-up (minimum 3 months elapsed since PVI). Follow-up comprised repeated Holter-monitoring and echocardiography. Variance was evaluated as standard deviation of segmental strain before PVI (STD). Prediction of success was modelled by binary logistic regression with LA min, STD and permanent AF before PVI. A ROC-curve was calculated from logistic probabilities and compared to LA areas and inter-segmental variance of LA strain as single predictors.
Results: Atrial fibrillation recurred in 40 of 89 patients. The logistic triple parameter model (-0.432*STD+0.091*LA_min+1.3*pAF) was the best predictor as assessed by Delong statistics (AUC 0.805; 0.713-0.897). LA areas (LA min 0.753, LA max 0.710), and STD (0.756) did not differ significantly in the ROC-model.
Conclusions: The logistic triple parameter model provides a rather sensitive and fairly specific prediction of persisting success of PVI and is superior to LA volume alone.
Author Disclosures: M. Grafe: None. C. Kriatselis: None. H. Gerds-Li: None. J. Kaufmann: None. V. Furundzija: None. U. Thanabalasingam: None. E. Fleck: None. E. Wellnhofer: None.
- © 2014 by American Heart Association, Inc.