U-shaped relationship between left atrium size on echocardiography and 1-year recurrence of atrial fibrillation after radiofrequency catheter ablation ― Prognostic value study ―

Abstract

Background: The larger the left atrium anteroposterior dimension (LAD) and left atrium volume (LAV), the stronger the association with recurrent atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). Patients with a smaller left atrium (LA) size, however, also have increased AF recurrence. Methods and Results: In 521 patients, routine 48-h Holter electrocardiogram and echocardiography were obtained at each outpatient visit every 3 months for 12 months. On multivariate analysis, AF type, LAD, and LAV calculated using the ellipsoid model/body surface area (LAVe/BSA) were independent predictors of AF recurrence. Patients were divided into 7 groups at 0.4-cm increments of LAD: ≤3 cm, LAD≤3 cm, 3.0 5.0 cm. Compared with the 3.4–3.8-cm group, the adjusted HR were 3.88 (95% CI: 2.02–7.46, P<0.001), 1.03 (95% CI: 0.50–2.12, P=0.939), 0.96 (95% CI: 0.52–1.77, P=0.901), 1.36 (95% CI: 0.72–2.57, P=0.347), 3.04 (95% CI: 1.67–5.53, P<0.001), and 4.07 (95% CI: 1.93–8.60, P<0.001), respectively. Similarly, we divided LAVe/BSA into 8 groups and also observed a U-shaped curve for AF recurrence. Conclusions: Both larger and smaller LAD and LAVe/BSA were associated with a higher risk of AF recurrence 1 year after RFCA. The association of LA size and AF recurrence after RFCA is represented by a U-shaped curve.