Portal de Periódicos da CAPES

Left atrial volume by cardiac computerized tomography using 3D reconstruction prior to catheter ablation: correlation with echocardiography and clinical outcomes

2024; Oxford University Press; Volume: 25; Issue: Supplement_1 Linguagem: Inglês

10.1093/ehjci/jeae142.018

2047-2412

A I Aguiar Neves, F Nunes, M Leite, Ricardo Henrique de Oliveira Braga Teixeira, Manuel Almeida, António Lobo, Jorge Almeida, Paulo Fonseca, M Ribeiro Silva, Maria João Oliveira, Helena Gonçalves, Rita Faria, Nuno Ferreira, João Primo, Ricardo Fontes‐Carvalho,

Cardiac Arrhythmias and Treatments

Abstract Introduction Accurate measurement of left atrial volume index (LAVI) using transthoracic echocardiography (TTE) may be challenging. The use of cardiac computed tomography angiography (CTA) for catheter ablation planning in patients with atrial fibrillation (AF) is common and may help to reduce some of the difficulties in accurately measuring left atrial (LA) volumes, particularly with the use of three-dimensional (3D) reconstruction techniques. However, this method is not yet fully validated. Methods Retrospective cohort including patients who underwent an index pulmonary vein isolation (PVI) procedure using CLOSE-protocol guided radiofrequency ablation (between 2018 and 2021 in a tertiary centre. Patients with moderate to severe valvular disease, congenital heart disease or rheumatic valvular disease were excluded. Cardiac CTA was performed in all patients prior to the procedure and 3D reconstruction of the LA was performed using an open-source imaging software. Echocardiographic LAVI measurements were based on the biplane method of disks. LA enlargement was defined by LAVI ≥ 55 ml/m2 on cardiac CTA or LAVI ≥ 35 ml/m2 on TTE. Results 120 patients (38% female; mean age 58 ± 9.5 years; 68% with a diagnosis of paroxysmal AF) were included in this analysis. Median follow up after PVI was 29 ± 6.5 months. Thirty-nine patients (33%) suffered AF recurrence during this period (after a blanking period of 90 days), of whom nine patients (7.5%) underwent a reablation procedure. The median LAVI on TTE in this population was 36 ± 5.5 ml/m2. Sixty-seven patients (56%) had LA enlargement when considering a cut-off of LAVI ≥ 35 ml/m2 on TTE. When considering cardiac CTA-derived values after 3D reconstruction of the LA, the median LAVI was 48 ml/m2 and 37 patients (31%) had LA enlargement when considering a cut-off of LAVI ≥ 55 ml/m2 on cardiac CTA. Thirty-four patients had LA enlargement according to both cardiac CTA and TTE measurements. LA measurements using cardiac CTA and TTE strongly correlated with each other, with a correlation coefficient of 0.612 (p<0.001) . In this cohort, no differences were found with regards to late recurrence or reablation procedures in patients with or without LA enlargement as defined by the cut-offs for LAVI on TTE (LAVI ≥ 35 ml/m2) or cardiac CTA (LAVI ≥ 55 ml/m2). Also, there were no significant differences in atrial volumes derived from TTE or cardiac CTA in patients who suffered AF recurrence when compared to those who did not. Conclusions LA volume measurement using 3D reconstruction techniques on cardiac CTA images may be a reasonable alternative to TTE measurements. LA enlargement, independent of measurement technique, did not predict AF recurrence in this population.