UPmémoires

English

Introduction: atrial fibrillation (AF) is the most frequent arrhythmia worldwide, and carries high healthcare costs. Catheter ablation is the most effective therapy to restore sinus rhythm, but success rates are variable, up to 80% after two procedures. Cardiac computed tomography angiography (CTA) is a highly efficient imaging technique to assess left atrium (LA) dimensions, left atrial appendage (LAA) and pulmonary veins (PV) but is still not recommended as first line method before ablation procedure. We sought to evaluate the prognostic value of left atrial parameters CTA for the risk of AF recurrence after a second procedure.

Population and methods: in this monocenter retrospective study, we included adults who underwent a second procedure of AF catheter ablation (AFCA) and measured 3D indexed LA volume (LAV) on first pre-procedural CTA, the number of PVs, coronary and valvular calcifications. Primary endpoint was the recurrence of AF after second AFCA.

Results: from 2009 to 2019, 136 consecutive patients underwent a second AFCA at Poitiers University Hospital. Mean age was 62 years, with 20% women. After a mean follow-up of 7 years, 62% of patients had a recurrence of AF. In multivariate analysis, a higher indexed LAV and female sex were the only independent variables associated with recurrence. An indexed LAV threshold of 84 ml/m² had the best performances to predict the risk of new AF episode, with relatively low AUC (0.62).

Conclusion: this study suggests LAV evaluated by CTA before first AFCA is a predictor of recurrence after a second procedure, with a threshold of 84 ml/m². Despite low performances, this was the only imaging factor associated with new episodes of FA. Further studies are mandatory to confirm the long-term prognostic role of CTA-assessed LVA in AFCA candidates, in order to refine the selection of patients who could benefit most from this procedures and avoid futile interventions.