title: Conventional versus 3-D Echocardiography to Predict Arrhythmia Recurrence After Atrial Fibrillation Ablation.
abstract: BACKGROUND
  Arrhythmia recurrence after atrial fibrillation (AF) ablation remains high and requires repeat interventions in a substantial number of patients. We assessed the value of conventional and 3-D echocardiography to predict AF recurrence.
  
  
  RESULTS
  Consecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Echocardiograms were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including 3-D left atrial (LA) volumetry and determination of LA function and sphericity. The primary endpoint, AF recurrence (>30 seconds) between 3 to 12 months after AF ablation, was independently adjudicated. We included 276 patients (73% male, mean age 59.9 ± 9.9 years). Paroxysmal and persistent AF were present in 178 (64%) and 98 (36%) patients, respectively. Mean left ventricular ejection fraction and indexed LA volume in 3-D (LAVI) were 52 ± 12% and 42 ± 13 mL/m2, respectively. AF recurrence was observed in 110 (40%) patients after a single procedure. Median (interquartile range) time to AF recurrence was 123 (92; 236) days. In multivariable Cox regression models, the only predictors for AF recurrence were the minimal, maximal, and indexed 3-D LA volumes, P = 0.024, P = 0.016, and P = 0.014, respectively. Quartile specific analysis of 3-D LAVI showed an HR of 1.885 (95%CI 1.066-3.334; P for trend = 0.015) for the highest compared to the lowest quartile.
  
  
  CONCLUSIONS
  Our results show the important role of LA volume for the long-term freedom from arrhythmia after AF ablation. These data also highlight the potential of 3-D echocardiography in this context and may facilitate patient selection for AF ablation.
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.|Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.|Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bossard
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Knecht
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Aeschbacher
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Ronny R
authors.initials: RR
authors.lastname: Buechel
authors.affiliation: Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.|Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hochgruber
authors.affiliation: Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.|Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Zimmermann
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Arnheid
authors.initials: A
authors.lastname: Kessel-Schaefer
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Frank-Peter
authors.initials: FP
authors.lastname: Stephan
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Gian
authors.initials: G
authors.lastname: Völlmin
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Maurice
authors.initials: M
authors.lastname: Pradella
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Beat A
authors.initials: BA
authors.lastname: Kaufmann
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.|Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada.|Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Conen
authors.affiliation: Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.|Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000009:adverse effects*; D018572:Disease-Free Survival; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; echocardiography; left atrium; outcome; pulmonary vein isolation; recurrence