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A novel predictive model for late recurrence after catheter ablation for atrial fibrillation using left appendage volume measured by cardiac computed tomography

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Abstract

Larger left atrial appendage (LAA) volume is associated with a higher risk of late recurrence (LR) in patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, it is unclear whether LAA volume predicts LR, independent of established risk factors. We sought to evaluate the value of LAA volume in predicting LR after RFCA for AF and to develop a score prediction model including LAA volume for these patients. We retrospectively studied 992 patients who underwent RFCA for AF and cardiac computed tomography before RFCA at a single center. At 3 years after RFCA, 362 patients (36.5 %) experienced recurrence. The multivariate Cox regression model showed that age ≥ 75 years (10 points), non-paroxysmal AF (9 points), diabetes mellitus (4 points), left atrial volume index (1 point per 10 ml/m2 rounded to the nearest integer), and the second (4.7 to < 7 ml/m2; 4 points) and third (≥ 7 ml/m2; 5 points) tertiles of the LAA volume index were independent risk factors LR. The above-mentioned risk factors were included in the integrated score model, and the C-index of the proposed score model was 0.715 (95 % confidence interval [CI] 0.679–0.752). LAA volume is an independent predictor of LR and the predictive model including LAA volume showed good discrimination power. These findings provide evidence for the inclusion of LAA volume in the risk stratification for AF recurrence in patients undergoing RFCA for AF.

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Acknowledgements

We would like to thank Hyun-Soo Lee, Ra-Seung Lim, and Sung Hyun Kang for their technical assistance and support in data preparation.

Funding

This work was supported by the Korea University Grant (JIC) and the Grant from Korea University Anam Hospital (JIC), Seoul, Republic of Korea.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Republic of Korea

    Do Young Kim, Yun Gi Kim, Jong-Il Choi, Ha Young Choi, Yun Young Choi, Seung Young Rho, Jaemin Shim, Jin Seok Kim & Young-Hoon Kim

  2. Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea

    Do Young Kim

  3. Division of Cardiology, Jeju National University Hospital, Jeju, Republic of Korea

    Ki Yung Boo

  4. Division of Cardiology, Ajou University Hospital, Suwon, Republic of Korea

    Kwang-No Lee

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  1. Do Young Kim
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Correspondence to Jong-Il Choi.

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Kim, D.Y., Kim, Y.G., Choi, JI. et al. A novel predictive model for late recurrence after catheter ablation for atrial fibrillation using left appendage volume measured by cardiac computed tomography. Int J Cardiovasc Imaging 37, 2063–2070 (2021). https://doi.org/10.1007/s10554-021-02169-4

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