title: Left atrial size and function by three-dimensional echocardiography to predict arrhythmia recurrence after first and repeated ablation of atrial fibrillation.
abstract: OBJECTIVE
  Left atrial (LA) size has been related to the success of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, potential predictors after a repeated procedure are unknown. We evaluate predictive factors related to successful AF ablation after a first and a repeated RFCA.
  
  
  RESULTS
  A total of 154 patients with AF were treated with RFCA. LA size and function were assessed with three-dimensional echocardiography (3D Echo) before RFCA. The effectiveness of RFCA was evaluated after 6 months. Recurrence of the arrhythmia was defined as any documented (clinically or by 24-h Holter recording) atrial tachyarrhythmia lasting >30 s after 12 weeks following RFCA. Of 154 patients, 103 (67%) underwent a first ablation (Group 1) and 51 (33%) a repeated RFCA (Group 2). At follow-up, arrhythmias were eliminated in 56 of 103 (54%) patients after a first RFCA and in 20 of 51 (40%) after a repeated ablation. In Group I, hypertension and LA expansion index derived from 3D Echo were independent predictors of arrhythmia elimination. In Group 2, only age predicted persistence of sinus rhythm; and only in younger patients (≤54 year old), though 3D LA maximal volumes were significantly smaller in those without when compared with those with AF recurrences.
  
  
  CONCLUSIONS
  A combination of the analysis of LA function with 3D Echo and clinical data predicts elimination of AF after a first ablation procedure for AF, beyond LA size. Among patients undergoing a repeated procedure, age and 3D echocardiographic LA maximum volume in younger patients predict the success of RFCA.
authors.affiliation: Department of Cardiology, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036 , Spain.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Montserrat
authors.forename: Luigi
authors.initials: L
authors.lastname: Gabrielli
authors.forename: Roger
authors.initials: R
authors.lastname: Borras
authors.forename: Sílvia
authors.initials: S
authors.lastname: Poyatos
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D009929:Organ Size; D011446:Prospective Studies; D012086:Reoperation
keywords: atrial fibrillation; atrial function; catheter ablation; predictors; three-dimensional echocardiography