Study On The Association Of Left Atrial Geometric Remodeling,anatomic Morphology Of The Pulmonary Veins And Coronary Artery Disease With Atrial Fibrillation Recurrence After Catheter Ablation Using 256-slice Computed Tomography

Part one Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablationObjective:To quantitatively investigate the impact of left atrial（LA）geometric remodeling on atrial fibrillation（AF）recurrence after catheter ablation（CA）.Methods:A retrospective analysis of 105 patients with AF who underwent left atrium and pulmonary vein imaging with 256-slice computed tomography before CA.Risk factors for AF recurrence were identified by multivariable logistic regression analysis and used to create a nomogram.Results:1.The recurrence group had significantly higher proportions of patients with heart failure and persistent AF,higher CHA₂DS₂-VASc and CHADS₂scores than the non-recurrence group（P<0.05）.2.Patients with recurrence had higher LA volume,LA sphericity,and lower LA ejection fraction（LAEF）（P<0.05）.There was no significant difference in asymmetry index between the two groups（P=0.121）.3.Multivariable regression analysis showed that LA minimal volume index（LAVImin）（OR:1.026,95%CI:1.002～1.050,P=0.034）,LA sphericity（OR:1.222,95%CI:1.040～1.435,P=0.015）and CHADS₂ score（OR:1.511,95%CI:1.024～2.229,P=0.038）were independent predictors of AF recurrence.4.The combined model of the LA sphericity to the LAVImin substantially increased the predictive power for AF recurrence（area under the curve[AUC]=0.736,95%CI:0.627～0.844,P<0.001）,with a sensitivity of 80%and a specificity of 61%.5.A nomogram was generated based on the contribution weights of the risk factors;the AUC was 0.772（95%CI:0.670～0.875）and had good internal validity.Conclusion:The CHADS₂ score,LA sphericity,and LAVImin were significant and independent predictors of AF recurrence after CA.Furthermore,the nomogram had a better predictive capacity for AF recurrence.Part two Impact of pulmonary vein anatomy and shape on late atrial fibrillation recurrence after catheter ablationObjective:To quantitatively investigate the impact of pulmonary vein anatomy and morphological characteristics on atrial fibrillation（AF）recurrence after catheter ablation（CA）.Methods:A retrospective analysis of 120 patients with AF who underwent left atrium and pulmonary vein imaging with 256-slice computed tomography before CA,including 60 patients with recurrence and 60 patients without recurrence.The clinical baseline characteristics of patients were recorded.Three-dimensional cardiac post-processing software were used for observing anatomical variation and measuring diameter,area and orientation of pulmonary veins（PVs）.Differences between the two groups were compared.Risk factors for AF recurrence were analyzed.Results:1.Typical PV anatomy（2 left and 2 right PVs）was identified in 108patients（90%）.Accessory PVs were observed in 8 patients（6%）,and one of them presented two right middle PVs.Common trunk PVs were detected in5 patients（4%）.There was no significant difference in pulmonary variants in the recurrence group and the nonrecurrence group（P>0.05）.2.The ostium area of left superior PV（LSPV）in the recurrence group was larger than that in the non-recurrence group[272.99（197.10,315.27）vs227.48（201.43,272.28）,P=0.049].The angle of LSPV in the transverse plane of the recurrence group was larger[20.70（14.05,24.4）vs 16.80（12.10,20.80）),P=0.035].There was no difference in the distance from the PV ostium to the first division（P>0.05）.3.Multivariate logistic regression analysis showed that LSPV ostium area（OR:1.008,95%CI:1.002～1.014,P=0.005）and angle of LSPV in the transverse plane（OR:1.053,95%:CI 1.003～1.106,P=0.038）were independent risk predictors of atrial fibrillation recurrence.Conclusion:Pulmonary vein ostium size and orientation evaluated by256-slice CT proved to be useful in predicting the AF recurrence.Part three Impact of coronary artery disease on the outcomes of catheter ablation in patients with atrial fibrillationObjective:To investigate possible impact of coronary artery disease（CAD）on clinical outcomes of catheter ablation in patients with atrial fibrillation（AF）.Methods:Patients with AF who underwent left atrium and pulmonary vein imaging with 256-slice computed tomography and catheter ablation were enrolled.The presence of stenotic severity and plaque characteristics of coronary arteries,clinical data,and adverse outcomes of catheter ablation were analyzed.Results:1.A total of 243 patients were enrolled,with CAD presence in 100（41%）patients.The CHA₂DS₂-VASc score of AF patients with CAD was significantly（P<0.001）higher than those without CAD.The presence of stenotic artery and plaques increased significantly with increase of CHA₂DS₂-VASc score（P<0.05）.2.The AF recurrence rate was 27%（64/243）in all patients,30%in patients with CAD,and 24%in patients without CAD,with no significant（P=0.343）difference between patients with and without CAD.3.There were no significant difference in artery lesion location,segment involvement score（SIS）and plaque characteristics between AF recurrence and no recurrence groups（P>0.05）.4.Age,AF type,duration of AF,heart failure,vascular disease,CHA₂DS₂-VASc score,LVEF,and left atrial antero-posterior diameter were significantly（P<0.05）correlated with AF recurrence in univariant analysis.Multivariable analysis revealed that duration of AF（HR 1.769,95%CI:1.027～3.048,P=0.040）,heart failure（HR 1.821,95%CI:1.067～3.107,P=0.028）and left atrial diameter（HR1.487,95%CI:1.059～2.088,P=0.022）remained significant independent predictors of AF recurrence.5.Patients with AF and concomitant CAD were significantly（P=0.030）associated with a worse outcome.Conclusion:Coronary artery disease concomitant with atrial fibrillation may be associated with a worse clinical outcome even though coronary artery disease does not significantly affect the risk of atrial fibrillation recurrence after ablation therapy.