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| Right Atrial Volume Predicts Acute Termination During Ablation of Atrial Fibrillation |
| 고려의대 순환기내과¹ , 고려의대 영상의학과² , 고려의대 흉부외과³ , 한양의대 구리병원 순환기내과⁴, 부천세종병원 순환기내과5 |
| 최종일¹, 최은정² , 정재승³ , Nagamoto Yasutsgu¹ , Tanubudi Daniel¹ , Yiu Kwan Ko¹ , 박환철⁴, 반지은¹ , 박재석¹ , 김진석5 ,임홍의 ¹ , 박상원¹ , 김영훈 ¹ |
Introduction: Left atrial (LA) volume is one of the predictors in successful outcome after catheter ablation of atrial fibrillation (AF). However, it has been demonstrated that right atrium (RA) is also responsible in AF maintenance and some of persistent AF can be terminated during RA ablation. We hypothesized that RA volume can independently predict termination of AF during ablation in patients with non-paroxysmal AF (NPAF). Methods: In sixty-three patients (54.6±10.5 years, 57 men, 34 NPAF), multi-detector CT (MDCT) scan for electroanatomical mapping was performed before ablation, and LA and RA volumes were measured, respectively. Pulmonary vein isolation (PVI), linear ablation or defragmentation of the LA and RA were sequentially performed. Subsequent atrial tachycardias (ATs) were mapped and then ablation was attempted.
Results: Both LA and RA volume were larger in patients with NPAF compared with paroxysmal AF (119.8±39.2 vs 92.0±28.2 ml, p=0.002; 155.3±57.9 vs 105.2±24.4 ml, p<0.001). Termination of AF or AT was observed in 40 patients (63.4%) during the procedure, and DC cardioversion was performed in others. RA volume was larger in patients without termination compared with those with termination (163.2±69.1 vs 117.9±33.7 ml, p=0.01), while there was no significant difference in LA volume. In multivariate analysis, RA volume predicted procedure failure (OR 1.025, 95% CI 1.006-1.044, p=0.009), and ROC curve showed RA volume >133 ml was a good cut-off value for prediction of procedure failure. In patients with NPAF, LA ablation in 16 patients and bi-atrial ablation in 18 patients were performed. Among the patients who underwent bi-atiral ablation, AF terminated in 3 patients (16.7%) and organized into AT in 6 patients (33.3%) during defragmentation at the RA. During follow-up after 3 months, the AF recurrence rate (5.6%) after bi-atrial ablation was lower than that after only LA ablation (25%), however, there was no statistical significance (p=0.164). Conclusions: Larger RA volume independent upon the LA volume is a useful parameter for predicting the failure of termination in patients with NPAF. In patients with sustained AF after PVI and LA ablation, RA ablation may be effective in eliminating AF or AT.
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