CTA predictive factors pr atrial fibrillation recurrence after redo catheter ablation procedure

atrial fibrillation (AF) is the most frequent arrhythmia worlwide, and carries major healthcare burden. AF catheter ablation (AFCA) is the most efficient therapy to restore sinus rhythm, but success rates vary: up to 80-90% after two procedures. Cardiac Computed Tomography Angiography (CCTA) is a highly efficient imaging technique to assess Left Atrium (LA) dimensions, left atrial appendage (LAA), pulmonary veins (PV) but is still not recommend as first line method before AFCA.

to evaluate prognostic value of CCTA-LA parameters for the risk of AF recurrence after redo procedure.

in this retrospective monocenter study conducted in a tertiary referral hospital, we included adults who underwent a second procedure of AFCA and measured 3D LA volume (LAV) on first pre-procedural CCTA, the number of PVs, coronary and valvular calcifications. Primary endpoint was the recurrence of AF after redo procedure.

from 2009 to 2019, 136 consecutive patients underwent a second AFCA at our institution. Mean age was 62 years, and 20% of patients were female. After a mean follow-up of 7 years, 62% of patients presented AF recurrence. In multivariate analysis, a higher indexed LAV and female sex were the only independent predictive factors associated with recurrence. An indexed threshold of 84 ml/m² had the best performances to predict new AF episode, with relatively limited AUC (0.62). Intraclass correlation of LAV assessment was very high (r=0.975; p<0.0001), reflecting excellent reproducibility.

this study suggests LAV evaluated by CCTA before first AFCA is a predictor of recurrence after redo procedure, with a threshold of 84 ml/m². Despite suboptimal performances, it is highly reproducible, and more importantly the only imaging parameter associated with recurrent episodes of AF. In order to refine the selection of patients undergoing AFCA and avoid futile procedures, further studies are mandatory to confirm the long term prognostic role of CCTA, beyond its current use.

Multivariate analysis - AF recurrence