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Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation

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Abstract

Cryoballoon ablation (CBA) is a safe and efficient therapeutic option for atrial fibrillation (AF). However, AF recurrence occurs in 25% of the patients, leading to repeated ablations and complications. Previous reports have shown that left atrium (LA) assessed by M-Mode and two-dimensional echocardiography (2DE) predicts AF recurrence. Nevertheless, these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process. We hypothesized that LA remodeling by three-dimensional echocardiography (3DE) has an additional value for AF recurrence prediction post-CBA. 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively recruited. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. 50 (29%) patients had AF recurrence. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50, 95% CI 1.34 -22.45, p < 0.001). In patients with non-dilated LA diameter index and LAVI by 2DE, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m2. LA remodeling by 3DE predicted AF recurrence, even in patients with non-dilated LA by M-Mode and 2DE, suggesting that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and it should be considered for systematic use to evaluate AF recurrence risk post-CBA.

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Funding

This work received a Grant from Universitair Ziekenhuis Brussel: “Wetenschappelijk Fonds Willy Gepts of the UZ Brussel.

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Authors and Affiliations

  1. Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium

    Andreea Motoc, Esther Scheirlynck, Bram Roosens, Maria-Luiza Luchian, Xavier Galloo, Berlinde von Kemp, Steven Droogmans & Bernard Cosyns

  2. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium

    Hadischat Chameleva & Maxim Gevers

  3. Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium

    Carlo de Asmundis

  4. CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Faculté de Médecine de Limoges, 16 INSERM 1094, 2, rue Marcland, 87000, Limoges, France

    Julien Magne

Authors
  1. Andreea Motoc
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  2. Esther Scheirlynck
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  4. Maria-Luiza Luchian
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  6. Maxim Gevers
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  11. Steven Droogmans
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  12. Bernard Cosyns
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Contributions

AM designed the study, collected data, wrote the statistical plan, cleaned and analyzed the data, drafted and revised paper. ES contributed to the data collection, analyzed data and revised the paper. BR designed data collection tools and revised the paper. MLL contributed to the data collection, analyzed data and revised the paper. HC contributed to data collection. MG contributed to data collection. XV contributed to the data collection and revised the paper. BvK contributed to the data collection, and revised the paper. CdA contributed to the data collection, and revised the paper. JM supervised the statistical analysis and revised the paper. SD supervised the project, data collection and revised the paper. BC initiated and supervised the project, drafted and revised the paper.

Corresponding author

Correspondence to Andreea Motoc.

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All authors declare that they have no conflict of interest to disclose.

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The study was approved by the local Ethical Committee and was carried out in accordance with the ethical principles for medical research involving human subjects established by Helsinki Declaration, protecting the privacy of all participants, as well as the confidentiality of their personal information.

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Written informed consent was obtained from all patients.

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Motoc, A., Scheirlynck, E., Roosens, B. et al. Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation. Int J Cardiovasc Imaging 38, 1103–1111 (2022). https://doi.org/10.1007/s10554-021-02493-9

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  • DOI: https://doi.org/10.1007/s10554-021-02493-9

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