title: Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation?
abstract: BACKGROUND
  Preprocedural factors may be helpful in selecting patients with atrial fibrillation (AF) for treatment with catheter ablation and in making an assumption regarding their prognosis. The aims of this study were to investigate whether left atrial (LA) volume and pulmonary venous (PV) anatomy, evaluated by computed tomography (CT) prior to ablation, will predict AF recurrence following catheter ablation.
  
  
  RESULTS
  We included 146 patients (mean age 57 +/- 11 years, 83% male) with symptomatic AF (55% paroxysmal, 18% persistent, 27% long-standing persistent). All patients underwent CT scanning prior to catheter ablation to evaluate LA volume and PV anatomy. Circumferential PV isolation was performed guided by Cartomerge electroanatomical mapping. The outcome was defined as complete success, improvement, or failure. After a mean follow-up of 19 +/-7 months, complete success was achieved in 59 patients (40%), and 38 patients (26%) demonstrated improvement. LA volume was found to be an independent predictor of AF recurrence with an adjusted OR of 1.14 for every 10-mL increase in volume (95% CI 1.00-1.29, P = 0.047). PV variations were equally distributed among the different outcomes of the ablation procedure, and therefore univariate analysis did not identify PV anatomy as a predictor of outcome.
  
  
  CONCLUSIONS
  LA volume is an independent predictor of AF recurrence after catheter ablation. Additionally, PV anatomy did not have any effect on the outcome. These findings suggest that an assessment of LA volume may be incorporated into the preprocedural evaluation of patients being considered for AF ablation.
authors.affiliation: Department of Cardiology, Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands.
authors.forename: Irene
authors.initials: I
authors.lastname: Hof
authors.forename: Karuna
authors.initials: K
authors.lastname: Chilukuri
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherr
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: Charles
authors.initials: C
authors.lastname: Henrikson
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Joseph
authors.initials: J
authors.lastname: Marine
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: D001027:Aortography / Q000379:methods*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010690:Phlebography / Q000379:methods*; D011379:Prognosis; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome