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Straube, Florian; Pongratz, Janis; Hartl, Stefan; Brueck, Benedikt; Tesche, Christian; Ebersberger, Ullrich; Helmberger, Thomas; Crispin, Alexander; Wankerl, Michael; Dorwarth, Uwe; Hoffmann, Ellen (2021): Cardiac computed tomography angiography-derived analysis of left atrial appendage morphology and left atrial dimensions for the prediction of atrial fibrillation recurrence after pulmonary vein isolation. In: Clinical Cardiology, Vol. 44, No. 11: pp. 1636-1645
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Abstract

BACKGROUND Left atrial appendage (LAA) is a potential source of atrial fibrillation (AF) triggers. HYPOTHESIS LAA morphology and dimensions are associated with AF recurrence after pulmonary vein isolation (PVI). METHODS From cardiac computed tomography angiography (CCTA), left atrial (LA), pulmonary vein (PV), and LAA anatomy were assessed in cryoballoon ablation (CBA) patients. RESULTS Among 1103 patients undergoing second-generation CBA, 725 (65.7%) received CCTA with 473 (42.9%) qualifying for detailed LAA analysis (66.3 ± 9.5 years). Symptomatic AF reoccurred in 166 (35.1%) patients during a median follow-up of 19 months. Independent predictors of recurrence were LA volume, female sex, and mitral regurgitation \geq°II. LAA volume and AF-type were dependent predictors of recurrence due to their strong correlations with LA volume. LA volumes \geq122.7~ml (sensitivity 0.53, specificity 0.69, area under the curve AUC 0.63) and LAA volumes $\geq$11.25 ml (sensitivity 0.39, specificity 0.79, AUC 0.59) were associated with recurrence. LA volume was significantly smaller in females. LAA volumes showed no sex-specific difference. LAA morphology, classified as windsock (51.4{\%}), chicken-wing (20.7{\%}), cactus (12.5{\%}), and cauliflower-type (15.2{\%}), did not predict successful PVI (log-rank; p~=~0.596). CONCLUSIONS LAA volume was strongly correlated to LA volume and was a dependent predictor of recurrence after CBA. Main independent predictors were LA volume, female sex, and mitral regurgitation $\geq$°II. Gender differences in LA volumes were observed. Individual LAA morphology was not associated with AF recurrence after cryo-PVI. Our results indicate that preprocedural CCTA might be a useful imaging modality to evaluate ablation strategies for patients with recurrences despite successful PVI.