Disparity between two-dimensional echocardiographic and electroanatomic left and right atrial volumes in patients undergoing catheter ablation for long-standing persistent atrial fibrillation

摘要

Left atrial (LA) volume (LAV) is used for the selection of patients with atrial fibrillation (AF) to rhythm control strategies. Calculation of LAV from the LA diameters and areas by two-dimensional (2D) echocardiography may result in significant error. Accuracy of atrial volume assessment has never been studied in patients with long-standing persistent AF (LSPAF) and significant atrial remodeling. This study investigated correlation and agreement between 2D echocardiographic (Simpson method) and electroanatomic (CARTO, Biosense Webster) left and right atrial (RA) volumes (LAV ECHO vs. LAV CARTO and RAV ECHO vs. RAV CARTO ) in patients undergoing catheter ablation for LSPAF. The study enrolled 173 consecutive subjects (females: 21 %, age: 59±9 years). There was only modest correlation between LAV ECHO (92±31 ml) and LAV CARTO (178±37 ml) (R=0.57), and RAV ECHO (71±29 ml) and RAV CARTO (173±34 ml) (R=0.42), respectively. LAV ECHO and RAV ECHO underestimated LAV CARTO and RAV CART O with the absolute bias (±1.96 standard deviation) of -85 (-148; -22) ml and -1 02 (-169; -35) ml, respectively, and with the relative bias of -48 (-75; -21) % and -59 (-88; -30) %, respectively (all P0.000001 for their mutual difference). Significant confounders of this difference were not identified. In patients with LSPAF, 2D echocardiography significantly underestimated both LA and RA volumes as compared with electroanatomic reference. This disagreement was independent of clinical, echocardiographic and mapping characteristics.