Left Atrial Volume Index Predicts Arrhythmia-Free Survival in Patients with Persistent Atrial Fibrillation Undergoing Cryoballoon Ablation

Abstract

Background: Pulmonary vein isolation (PVI) using cryoballoon ablation (PVI-C) is increasingly performed as a first-line strategy for the treatment of patients with persistent atrial fibrillation (PersAF); however, follow-up data and predictors of procedural success are lacking.

Objective: To study the efficacy of PVI-C in patients with PersAF, focusing on predictors of procedural success.

Methods: By retrospective review, 148 consecutive patients with PersAF who underwent PVI-C were analyzed. The impact of several variables on outcome was evaluated in univariate and multivariate analyses and Cox proportional hazards regression models.

Results: After a mean follow-up of 19.2±10.9 months, 75 (50.7%) patients remained arrhythmia-free without the need for antiarrhythmic drug therapy. Patients with a normal left atrial volume index (LAVI) achieved a 71.0% arrhythmia-free survival. LAVI was the most powerful predictor of procedural success.

Conclusions: Arrhythmia-free survival after PVI-C in select patients with PersAF are promising. Moreover, LAVI is a valuable measurement to help guide ablation strategy and predict outcome when using cryoballoon ablation.

Keywords: Catheter ablation; Cryoablation; Cryoballoon; Left atrial volume index; Persistent atrial fibrillation; Pulmonary vein isolation.

Figures

Figure 1.. Sample left atrial volume measurement in a patient with a moderately dilated left atrium. Note that atrial size is underappreciated by left atrial diameter.

Figure 2.. Arrhythmia-free survival without antiarrhythmic drug therapy following pulmonary vein isolation by cryoballoon ablation.

Figure 3.. Examination of sub-groups (by left atrial volume index) from normal to severe left atrial enlargement. Arrhythmia-free survival without antiarrhythmic drug therapy following pulmonary vein isolation by cryoballoon ablation.