Does Left Atrial Dilation Predict Atrial Fibrillation Severity and Post-ablation Outcomes Among Individuals with Atrial Fibrillation?

Friday, August 26, 2022

5:45 PM – 6:00 PM CEST

Location: C1M1

Publication Number: 98

Background: Changes in left atrium (LA) dimensions occur with atrial fibrillation (AF) and increase with AF duration. Particularly anterior-posterior atrium width relative to height. This is hypothesized to indicate AF related pathology and predict ablation effectiveness or embolic stroke.

Objectives: To examine whether width-to-height LA dilation measured by CARTO mapping data predicts paroxysmal AF (PAF) vs persistent AF (PsAF) or post-ablation outcomes.

Methods: CARTO procedural ablation characteristics were loaded to CARTONET (a cloud-based artificial intelligence powered system) and linked to deidentified Mercy Health electronic health record (EHR) data among AF patients who underwent ablation. The first ablation was classified as the index ablation. Following an automatic anatomical segmentation of the atria, LA dilation was calculated as the ratio of posterior width to posterior height. Patient characteristics (AF type, BMI, age, Elixhauser Comorbidity Index score, and CHA2DS2-VASC score) were assessed at index and derived from EHR. Logistic regression examined the relationship of LA dilation with: 1) AF type at index and 2) AF recurrence 12-month post-ablation (a composite of repeat ablation, electrical cardioversion, and AF rehospitalization), controlling for patient characteristics.

Results: Among 202 patients, PsAF had significantly lower LA dilation scores than PAF patients (1.61 vs. 1.79, <0.005). One unit increase in dilation (range: 0.76 to 3.10) was associated with 66% lower likelihood of PsAF (adjusted odds ratio [aOR] 0.34, 95% confidence interval [CI] 0.17-0.68, p=0.002). LA dilation score did not predict AF recurrence (1.71 vs 1.69 in patients with vs without recurrence, aOR 1.31, 95% CI 0.60-2.87, p=0.494).

Conclusions: LA width-to-height dilation predicted AF severity at index but not ablation effectiveness. Atrial structural shape changes measured by CARTO may be used for diagnostic and prediction purposes.

Presenting Author(s)

Paul M. Coplan, MBA, ScD, FISPE

Vice President and head of Medical Device Epidemiology and Real-World Data Sciences
University of Pennsylvania School of Medicine
Fort Washington, Pennsylvania, United States

Slides

Co-Author(s)

AD

Amit Doshi, MD

Mercy Clinic, St. Louis, Missouri, USA, United States
LT

Liat Tsoref

Johnson & Johnson, Israel
YA

Yariv Avraham Amos

Johnson & Johnson, Israel
MA

Mati Amit

Johnson & Johnson, Israel
CW

Charlene Wong, MPH

Johnson & Johnson, United States
GC

Guy Cafri

Johnson & Johnson
San Diego, California, United States
RAHUL KHANNA

Johnson & Johnson
New Brunswick, New Jersey, United States