title: Right atrial volume is superior to left atrial volume for prediction of atrial fibrillation recurrence after direct current cardioversion.
abstract: BACKGROUND
  The value of right atrial volume as a predictor for recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV) is unknown.
  
  
  METHODS
  We sought to compare the performance of right atrial volume indexed to body surface area (RAVI), left atrial diameter, left atrial volume indexed to body surface area (LAVI), and biatrial volume index (BAVI) for the prediction of AF recurrence at 6 months after DCCV. This study included the first 95 consecutive patients from the AF Clinic at a large tertiary care hospital who underwent DCCV and who had an echocardiogram available within 6 months before DCCV. Maximal LAVI, RAVI, and BAVI were determined from the echocardiogram before DCCV. Electrocardiographic and clinical data were acquired at baseline, before cardioversion, and at each clinic visit.
  
  
  RESULTS
  Of the 95 patients (64 male; mean age, 63 ± 12 years), history of systemic hypertension, diabetes mellitus, heart failure, and transient ischemic attack/stroke was present in 60 (63%), 14 (15%), 27 (28%), and 5 (5%) patients, respectively. Mean duration from AF diagnosis to DCCV was 3.5 ± 5.0 years. At 6 months after DCCV, 53 (56%) had reverted to AF. RAVI had superior predictive ability (area under the receiver operator characteristic curve: RAVI, 0.77; left atrial diameter, 0.54; LAVI, 0.64; and BAVI, 0.70). RAVI ≥ 42 mL/m(2) provided the best accuracy for prediction of recurrence (76% accuracy, 71% sensitivity, 83% specificity, 90% positive predictive value, and 56% negative predictive value). Best accuracy for LAVI was ≥ 48 mL/m(2) (70% accuracy, 53% sensitivity, 79% specificity, 85% positive predictive value; 43% negative predictive value).
  
  
  CONCLUSIONS
  RAVI is superior to LAVI for the prediction of AF recurrence at 6 months after DCCV.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Luong
authors.affiliation: EMMES Canada, Burnaby, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Darby J S
authors.initials: DJ
authors.lastname: Thompson
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Gin
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Jue
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marion E
authors.initials: ME
authors.lastname: Barnes
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Colley
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: t.tsang@ubc.ca.
authors.forename: Teresa S M
authors.initials: TS
authors.lastname: Tsang
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D016279:Atrial Function, Left / Q000502:physiology*; D004452:Echocardiography / Q000379:methods; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D013997:Time Factors