Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicentre LAGO-AF study
Por:
Bisbal, F, Alarcon, F, Ferrero-de-Loma-Osorio, A, Gonzalez-Ferrer, JJ, Alonso, C, Pachon, M, Tizon, H, Cabanas-Grandio, P, Sanchez, M, Benito, E, Teis, A, Ruiz-Granell, R, Perez-Villacastin, J, Vinolas, X, Arias, MA, Valles, E, Garcia-Campo, E, Fernandez-Lozano, I, Villuendas, R, Mont, L
Publicada:
1 sep 2018
Resumen:
Aims Left atrial (LA) remodelling is a key determinant of atrial fibrillation (AF) ablation outcome. Optimal methods to assess this process are scarce. LA sphericity is a shape-based parameter shown to be independently associated to procedural success. In a multicentre study, we aimed to test the feasibility of assessing LA sphericity and evaluate its capability to predict procedural outcomes.
Methods and results This study included consecutive patients undergoing first AF ablation during 2013. A 3D model of the LA chamber, excluding pulmonary veins and LA appendage, was used to quantify LA volume (LAV) and LA sphericity (>= 82.1% was considered spherical LA). In total, 243 patients were included across 9 centres (71% men, aged 56 +/- 10 years, 44% with hypertension and 76% CHA2DS2-VASc <= 1). Most patients had paroxysmal AF (66%) and underwent radiofrequency ablation (60%). Mean LA diameter (LAD), LAV, and LA sphericity were 42 +/- 6 mm, 100 +/- 33 mL, and 82.6 +/- 3.5%, respectively. Adjusted Cox models identified paroxysmal AF [hazard ratio (HR 0.54, P = 0.032)] and LA sphericity (HR 1.87, P = 0.035) as independent predictors for AF recurrence. A combined clinical-imaging score [Left Atrial Geometry and Outcome (LAGO)] including five items (AF phenotype, structural heart disease, CHA2DS2-VASc <= 1, LAD, and LA sphericity) classified patients at low (<= 2 points) and high risk (>= 3 points) of procedural failure (35% vs. 82% recurrence at 3-year follow-up, respectively; HR 3.10, P < 0.001).
Conclusion In this multicentre, real-life cohort, LA sphericity and AF phenotype were the strongest predictors of AF ablation outcome after adjustment for covariates. The LAGO score was easy to implement, identified high risk of procedural failure, and could help select optimal candidates.
Filiaciones:
Bisbal, F:
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Ctra Canyet S-N, Barcelona 08916, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Alarcon, F:
Univ Barcelona, IDIBAPS, Hosp Clin, Atrial Fibrillat Unit UFA, Villarroel 170, E-08036 Barcelona, Spain
Ferrero-de-Loma-Osorio, A:
Hosp Clin Valencia, Av Blasco Ibanez 17, Valencia 46010, Spain
Gonzalez-Ferrer, JJ:
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Hosp Clin San Carlos, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Alonso, C:
Hosp Santa Creu & Sant Pau, Carrer St Quinti 89, Barcelona 08041, Spain
Pachon, M:
Hosp Virgen Salud, Av Barber 30, Toledo 45004, Spain
Tizon, H:
Hosp Mar, Passeig Maritim 25-29, Barcelona 08003, Spain
Cabanas-Grandio, P:
Hosp Alvaro Cunqueiro, Vigo, Spain
Sanchez, M:
Hosp Puerta Hierro, Calle Manuel de Falla 1, Madrid 28222, Spain
Benito, E:
Univ Barcelona, IDIBAPS, Hosp Clin, Atrial Fibrillat Unit UFA, Villarroel 170, E-08036 Barcelona, Spain
Teis, A:
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Ctra Canyet S-N, Barcelona 08916, Spain
Ruiz-Granell, R:
Hosp Clin Valencia, Av Blasco Ibanez 17, Valencia 46010, Spain
Perez-Villacastin, J:
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Hosp Clin San Carlos, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Carrer St Quinti 89, Barcelona 08041, Spain
Arias, MA:
Hosp Virgen Salud, Av Barber 30, Toledo 45004, Spain
Valles, E:
Hosp Mar, Passeig Maritim 25-29, Barcelona 08003, Spain
Garcia-Campo, E:
Hosp Alvaro Cunqueiro, Vigo, Spain
Fernandez-Lozano, I:
Hosp Puerta Hierro, Calle Manuel de Falla 1, Madrid 28222, Spain
Villuendas, R:
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Ctra Canyet S-N, Barcelona 08916, Spain
Mont, L:
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Univ Barcelona, IDIBAPS, Hosp Clin, Atrial Fibrillat Unit UFA, Villarroel 170, E-08036 Barcelona, Spain
Bronze, Green Accepted
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