Relation of Volume and Dominant Frequency of Left Atrium and Left Atrial Appendage on the Induction of Atrial Fibrillation after Ablation

DOI 16 References Open Access
  • Sonoda Kazumasa
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Okumura Yasuo
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Watanabe Ichiro
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Nagashima Koichi
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Kofune Masayoshi
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Mano Hiroaki
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Kogawa Rikitake
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Sasaki Naoko
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Ohkubo Kimie
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Nakai Toshiko
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine
  • Hirayama Atsushi
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine

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Other Title
  • 心房細動アブレーション後の心房細動誘発性と左房本体および，左心耳の容積とdominant frequencyの関係

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Background : The left atrial appendage (LAA) has been reported to be a key contributor to the maintenance of atrial fibrillation (AF). High dominant frequency (DF) sites detected by fast fourier transform (FFT) analyses are known as electrical substrates for AF. We therefore investigated the association between the LA body and LAA volumes and DFs in for the sequence of AF ablation. Methods and Results : Multi-slice CT was performed in 46 AF patients (paroxysmal 27 ; persistent 19) who underwent catheter ablation. Before the ablation, the LA and LAA volume were measured, and the LA and LAA DF value during AF was calculated. AF was no longer inducible after the pulmonary vein isolation (PVI) in 27 patients (PVI responders) whereas it was still inducible in the remaining 19 (PVI nonresponders). Among the PVI nonresponders, a PVI plus complex fractionated atrial electrogram (CFAE) ablation and/or LA linear ablation terminated the AF in 7 patients (LA-ABL responders), but did not in 12 (LA-ABL nonresponders). The PVI nonresponders had a larger LA volume (121.8±7.2mm3 vs. 98.8±7.1mm3, p=0.0285) and modestly larger LAA volume than the PVI responders (14.4±1.0mm3 vs. 12.3±1.0mm3, p=0.1399). The LA and LAA DF values significantly increased in the PVI nonresponders compared to the PVI responders (LA : 6.8±0.2Hz vs. 6.1±0.2Hz, p=0.0429 ; LAA : 6.7±0.2Hz, vs. 6.0±0.2Hz, p=0.0164). Among the PVI nonresponders, the LAA volume was significantly larger in the LA-ABL responders than in the LA-ABL nonresponders (17.1±1.4mm3 vs. 11.6±1.2mm3, p=0.0102), but there was no difference in the LA volume (126.7±12.4mm3 vs. 111.9±10.5mm3, p=0.3770). Incremental increases in the LA and LAA DF values were noted in the LA-ABL responders and nonresponders (LA-DF 6.6±0.5Hz vs. 7.0±0.4Hz, p=0.4955 ; LAA-DF 6.3±0.4Hz vs. 7.0±0.3Hz, p=0.2122). Conclusions : Patients who responded to the PVI had a smaller LA volume and lower DF value in the LA and LAA. In patients refractory to PVI, a larger LAA volume and relatively lower LAA DF value might be a useful indicator for AF termination by additional CFAE/linear ablation in the LA.

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