Novel Method for Risk Stratification of Major Adverse Clinical Events Using Pre- and Post-Ablation Left Atrial Volume Index in Patients With Persistent Atrial Fibrillation.

Background: The relationship between changes in the left atrial volume index (LAVI) post-catheter ablation (CA) and long-term prognostic events in patients with persistent atrial fibrillation (AF) remains unclear. We evaluated the incidence of major adverse clinical events (MACE), including all-cause death, unplanned heart failure hospitalization, and unplanned cardiovascular hospitalization using pre- and post-CA LAVI.

Methods and results: We collected data retrospectively from 150 patients with persistent AF who underwent their first CA. LAVI was calculated during preprocedural echocardiography under AF rhythm (pre-CA LAVI) and 3 months post-CA under sinus rhythm (post-CA LAVI). The cumulative incidence of MACE was compared among 3 subgroups based on the cutoff values of pre-CA (45.5 mL/m²) and post-CA (46.5 mL/m²; both determined using the c-statistic) LAVI. The subgroup of a pre-CA LAVI >45.5 mL/m² with a post-CA LAVI >46.5 mL/m² (n=45) had a significantly higher MACE incidence compared with other subgroups (P=0.002). Multivariate analysis identified this subgroup as independently at higher risk for MACE. The subgroup of a pre-CA LAVI >45.5 mL/m² with a post-CA LAVI ≤46.5 mL/m² (n=49) had an incidence comparable with those with pre-CA LAVI ≤45.5 mL/m² (n=56) and exhibited a significantly greater reduction in LAVI than other subgroups did (P<0.001).

Conclusions: Combining pre-CA and post-CA LAVIs is valuable in stratifying long-term MACE development risk following CA.