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Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Clinic of Cardiology, University Clinical Centre of Kosova; Medical Faculty, University of Prishtina, Prishtina, Kosovo.ORCID-id: 0000-0003-0410-968X
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Clinic of Cardiology, University Clinical Centre of Kosova.ORCID-id: 0000-0002-8996-4257
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Molecular & Clinical Sciences Research Institute, St George University, and Brunel University, London, UK.ORCID-id: 0000-0002-6089-5614
2020 (engelsk)Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 40, nr 1, s. 1-13Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

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 center dot 99 ([95% CI 2 center dot 50-3 center dot 47], P<0 center dot 001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0 center dot 0001 for both), larger LA area (P<0 center dot 0001), lower LA strain (P<0 center dot 0001) and lower LA total emptying fraction (LA EF) (P<0 center dot 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 center dot 1[95% CI, -1.3-10 center dot 4], P<0 center dot 0001), followed by LA diameter >= 50 mm (OR: 2 center dot 75, [95% CI 1 center dot 66-4 center dot 56,] P<0 center dot 0001), and LAVmax >150 ml (OR: 2 center dot 25, [95% CI, 1.1-5 center dot 6], P = 0 center dot 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.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2020. Vol. 40, nr 1, s. 1-13
Emneord [en]
atrial fibrillation, catheter ablation, left atrium, predictors, recurrences
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-165108DOI: 10.1111/cpf.12595ISI: 000491763200001PubMedID: 31556215Scopus ID: 2-s2.0-85074350417OAI: oai:DiVA.org:umu-165108DiVA, id: diva2:1369994
Tilgjengelig fra: 2019-11-13 Laget: 2019-11-13 Sist oppdatert: 2020-01-08bibliografisk kontrollert

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