Predictive value of left atrium wall thickness on recurrences after pulmonary vein isolation

Rhythm control strategy through pulmonary vein isolation(PVI) is the primary choice in atrial fibrillation(AF). Long-term success after ablation includes left atrium anatomical and structural features in addition to ablation strategies. Atrial wall thickness contributes to the development of atrial remodeling, thereby influencing the progression of AF. This study aimed to investigate the relationship between left atrium wall thickness (LAWT) and recurrence after the procedure.

This study involves AF patients who underwent PVI with cryoballoon ablation between 2019 - 2022. The pre-procedural cardiac CT scans of the patients were retrospectively analyzed using ADAS3D software, with a specific focus on assessing (LAWT). Left atrial wall thickness was analyzed in four distinct regions; anterior, posterior,septal and roof. Comparison was made of the LAWT between the recurrent group and the non-recurrent group.

A total of 186 patiens ( mean age 59.7±11.4 years, 99 (%53.2) male) were enrolled. The average volume of the left atrium was measured 122.62±37 mL, and the mean thickness of the LA wall was 1.57 ± 0.2 mm. After a median follow up 21 (IQR :13- 31) months AF recurrence was observed in a 56 patients. In the comparison between the recurrent (Fig. 1A) and non-recurrent(Fig. 1B) groups, the LAWT was found to be significantly thinner in the recurrent group ( 1.51 ± 0.26, 1.60 ± 0.17 p= 0.045 ). Furthermore, when examining regional wall thickness in this group, the thinnest wall was observed in the anterior wall 1.43 ± 0.31 . The area under the curve for the LAWT peak was 0.591 (95% CI: 0.50-0.683; p:0.048). Using a cut-off value of 1.1485 mm, the LAWT predicted recurrens during follow-up (Fig 2.).

Left atrial wall thickness is associated with substrate development and may serve as an independent predictor of AF recurrence. Pre-procedural wall thickness measurements can help tailor treatment strategies to the individual patient.Fig. 1  Fig. 2