BACKGROUND: Left atrial (LA) enlargement has been identified as a predictor of worse clinical outcome after catheter ablation for atrial fibrillation (AF). We investigated the correspondence of LA size parameters assessed by echocardiography, CT and 3D electroanatomical mapping in patients with AF treated by catheter ablation. METHODS: We analyzed echocardiographic LA volume measurements by disc summation method (LAVDISC), computed tomography (LAVCT) and 3D electroanatomical mapping (LAVCARTO) in 100 pts. (71% males; aged 63 ± 8 years; paroxysmal AF in 55% of patients). RESULTS: Mean LAVDISC was 83 ± 25 ml (median: 115; IQR: 98-140 ml), mean LAVCT was 120 ± 34 ml (median: 115; IQR: 98-140 ml) and mean LAVCARTO was 123 ± 36 ml (median: 118; IQR: 99-132 ml). Pearson's correlation coefficient between LAVDISC a LAVCT was 0.6 (p < 0.0001) and between LAVCARTO and LAVCT was 0.79 (p < 0.0001). There was a significant difference between the two correlation coefficients (p < 0.004). The absolute difference between LAVCARTO and LAVCT (3.5 (95% CI -42 - 43) ml) was significantly lower (p < 0.0001) as compared to LAVDISC and LAVCT (- 39 (95% CI -102 - 24) ml). In opposite to LAVDISC, the bias between LAV obtained by CT and CARTO did not differentiate according to presence of spherical remodeling (1.7 ± 28 vs. vs. 5.1 ± 31 ml). Only presence of sinus rhythm was significant and independent covariate of the difference between CARTO and CT-derived LAVs by multivariate regression analysis. CONCLUSIONS: Even though LA volumes evaluated by 3D-electroanatomical mapping have quite good accuracy, the precision is low. For volumes estimated by echocardiography, both precision and accuracy are low.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University and General University Hospital U Nemocnice 2 128 08 Prague Czech Republic

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital U Nemocnice 2 Prague 128 08 Czech Republic

Zobrazit více v PubMed

Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14:528–606. doi: 10.1093/europace/eus027. PubMed DOI

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–962. PubMed

Berruezo A, Tamborero D, Mont L, Benito B, Tolosana JM, Sitges M, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007;28:836–841. doi: 10.1093/eurheartj/ehm027. PubMed DOI

von Bary C, Dornia C, Eissnert C, Nedios S, Roser M, Hamer OW, et al. Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2012;34:181–188. doi: 10.1007/s10840-011-9641-6. PubMed DOI

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39. doi: 10.1016/j.echo.2014.10.003. PubMed DOI

Badano LP, Pezzutto N, Marinigh R, Cinello M, Nucifora G, Pavoni D, et al. How many patients would be misclassified using M-mode and two-dimensional estimates of left atrial size instead of left atrial volume? A three-dimensional echocardiographic study. J Cardiovasc Med. 2008;9:476–484. doi: 10.2459/JCM.0b013e3282f194f0. PubMed DOI

Hof I, Arbab-Zadeh A, Scherr D, Chilukuri K, Dalal D, Abraham T, et al. Correlation of left atrial diameter by echocardiography and left atrial volume by computed tomography. J Cardiovasc Electrophysiol. 2009;20:159–163. doi: 10.1111/j.1540-8167.2008.01310.x. PubMed DOI

Vandenberg BF, Weiss RM, Kinzey J, Acker M, Stark CA, Stanford W, et al. Comparison of left atrial volume by two-dimensional echocardiography and cine-computed tomography. Am J Cardiol. 1995;75:754–757. doi: 10.1016/S0002-9149(99)80676-6. PubMed DOI

Rodevan O, Bjornerheim R, Ljosland M, Maehle J, Smith HJ, Ihlen H. Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Card Imaging. 1999;15:397–410. doi: 10.1023/A:1006276513186. PubMed DOI

Mor-Avi V, Yodwut C, Jenkins C, Kuhl H, Nesser HJ, Marwick TH, et al. Real-time 3D echocardiographic quantification of left atrial volume: multicenter study for validation with CMR. JACC Cardiovasc Imaging. 2012;5:769–777. doi: 10.1016/j.jcmg.2012.05.011. PubMed DOI

Lester SJ, Ryan EW, Schiller NB, Foster E. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol. 1999;84:829–832. doi: 10.1016/S0002-9149(99)00446-4. PubMed DOI

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–1463. doi: 10.1016/j.echo.2005.10.005. PubMed DOI

Havranek Stepan, Fiala Martin, Bulava Alan, Sknouril Libor, Dorda Miroslav, Bulkova Veronika, Fingrova Zdenka, Souckova Lucie, Palecek Tomas, Simek Jan, Linhart Ales, Wichterle Dan. Multivariate Analysis of Correspondence between Left Atrial Volumes Assessed by Echocardiography and 3-Dimensional Electroanatomic Mapping in Patients with Atrial Fibrillation. PLOS ONE. 2016;11(3):e0152553. doi: 10.1371/journal.pone.0152553. PubMed DOI PMC

Sknouril L, Havranek S, Bulkova V, Dorda M, Palecek T, Simek J, et al. Disparity between two-dimensional echocardiographic and electroanatomic left and right atrial volumes in patients undergoing catheter ablation for long-standing persistent atrial fibrillation. Physiol Res. 2017;66:241–249. PubMed

Piorkowski C, Hindricks G, Schreiber D, Tanner H, Weise W, Koch A, et al. Electroanatomic reconstruction of the left atrium, pulmonary veins, and esophagus compared with the "true anatomy" on multislice computed tomography in patients undergoing catheter ablation of atrial fibrillation. Heart Rhythm. 2006;3:317–327. doi: 10.1016/j.hrthm.2005.11.027. PubMed DOI

Martinek M, Nesser HJ, Aichinger J, Boehm G, Purerfellner H. Accuracy of integration of multislice computed tomography imaging into three-dimensional electroanatomic mapping for real-time guided radiofrequency ablation of left atrial fibrillation-influence of heart rhythm and radiofrequency lesions. J Interv Card Electrophysiol. 2006;17:85–92. doi: 10.1007/s10840-006-9067-8. PubMed DOI

Ejima K, Shoda M, Yagishita D, Futagawa K, Yashiro B, Sato T, et al. Image integration of three-dimensional cone-beam computed tomography angiogram into electroanatomical mapping system to guide catheter ablation of atrial fibrillation. Europace. 2010;12:45–51. doi: 10.1093/europace/eup371. PubMed DOI

Muller H, Burri H, Gentil P, Lerch R, Shah D. Measurement of left atrial volume in patients undergoing ablation for atrial fibrillation: comparison of angiography and electro-anatomic (CARTO) mapping with real-time three-dimensional echocardiography. Europace. 2010;12:792–797. doi: 10.1093/europace/euq031. PubMed DOI

Bisbal F, Guiu E, Calvo N, Marin D, Berruezo A, Arbelo E, et al. Left atrial sphericity: a new method to assess atrial remodeling. Impact on the outcome of atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2013;24:752–759. doi: 10.1111/jce.12116. PubMed DOI

Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. J Am Soc Echocardiogr. 2011;24:229–267. doi: 10.1016/j.echo.2010.12.008. PubMed DOI

Cozma D, Popescu BA, Lighezan D, Lucian P, Mornos C, Ginghina C, et al. Left atrial remodeling: assessment of size and shape to detect vulnerability to atrial fibrillation. Pacing Clin Electrophysiol 2007;30 Suppl 1:S147–50. PubMed

Tsao HM, Yu WC, Cheng HC, Wu MH, Tai CT, Lin WS, et al. Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging. J Cardiovasc Electrophysiol. 2001;12:809–813. doi: 10.1046/j.1540-8167.2001.00809.x. PubMed DOI

Kurotobi T, Iwakura K, Inoue K, Kimura R, Toyoshima Y, Ito N, et al. The significance of the shape of the left atrial roof as a novel index for determining the electrophysiological and structural characteristics in patients with atrial fibrillation. Europace. 2011;13:803–808. doi: 10.1093/europace/eur039. PubMed DOI

Nedios S, Tang M, Roser M, Solowjowa N, Gerds-Li JH, Fleck E, et al. Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation: predictive value after ablative treatment. J Interv Card Electrophysiol. 2011;32:87–94. doi: 10.1007/s10840-011-9591-z. PubMed DOI

Nikitin NP, Witte KK, Thackray SD, Goodge LJ, Clark AL, Cleland JG. Effect of age and sex on left atrial morphology and function. Eur J Echocardiogr. 2003;4:36–42. doi: 10.1053/euje.4.1.36. PubMed DOI

Ujino K, Barnes ME, Cha SS, Langins AP, Bailey KR, Seward JB, et al. Two-dimensional echocardiographic methods for assessment of left atrial volume. Am J Cardiol. 2006;98:1185–1188. doi: 10.1016/j.amjcard.2006.05.040. PubMed DOI

Nedios S, Koutalas E, Kosiuk J, Sommer P, Arya A, Richter S, et al. Impact of asymmetrical dilatation of the left atrium on the long-term success after catheter ablation of atrial fibrillation. Int J Cardiol. 2015;184:315–317. doi: 10.1016/j.ijcard.2015.02.078. PubMed DOI

Osmanagic A, Moller S, Osmanagic A, Sheta HM, Vinther KH, Egstrup K. Left atrial Sphericity index predicts early recurrence of atrial fibrillation after direct-current cardioversion: an echocardiographic study. Clin Cardiol. 2016;39:406–412. doi: 10.1002/clc.22545. PubMed DOI PMC

Fingrova Z, Havranek S, Marek J, Lambert L, Linhart A. Correspondence between left atrial size estimated by echocardiography, CT and electroanatomical mapping in patients with atrial fibrillation. EuroHeartCare 2017. European Journal of Cardiovasc Nursing. 2017;16 Suppl. 1:S79.