Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis.

Autor: Bajraktari G; Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo.; Medical Faculty, University of Prishtina, Prishtina, Kosovo., Bytyçi I; Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo., Henein MY; Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.; Molecular & Clinical Sciences Research Institute, St George University, London, UK.; Brunel University, London, UK.
Jazyk: angličtina
Zdroj: Clinical physiology and functional imaging [Clin Physiol Funct Imaging] 2020 Jan; Vol. 40 (1), pp. 1-13. Date of Electronic Publication: 2019 Oct 21.
DOI: 10.1111/cpf.12595
Abstrakt: Background: Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF.
Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included.
Results: The pooled analysis showed that after a follow-up period of 21 ± 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2·99 ([95% CI 2·50-3·47], P<0·001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0·0001 for both), larger LA area (P<0·0001), lower LA strain (P<0·0001) and lower LA total emptying fraction (LA EF) (P<0·0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3·1[95% CI, -1.3-10·4], P<0·0001), followed by LA diameter ≥50 mm (OR: 2·75, [95% CI 1·66-4·56,] P<0·0001), and LAVmax >150 ml (OR: 2·25, [95% CI, 1.1-5·6], P = 0·0002).
Conclusions: Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
(© 2019 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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