Is the presence of left atrial diverticulum associated with recurrence in patients undergoing catheter ablation for atrial fibrillation?

Introduction: Catheter ablation (CA) for atrial fibrillation (AF) has been a major cornerstone in the management of AF. Despite promising advances in CA techniques, long-term results reveal a high rate of recurrence after the procedure. Left atrial diverticulum (LAD), a common anatomic variant of the left atrium, was previously shown to be associated with increased risk of thrombus formation, cardiac perforation and arrhythmia. In this study we aimed to investigate the relationship between LAD and recurrence in patients undergoing CA for AF.

Material And Methods: A total of 100 consecutive patients with a mean age of 53 ±12.1 years (53% male) underwent radiofrequency (RF) (46, 46%) or cryoballoon (54, 54%) catheter ablation for atrial fibrillation preceded by cardiac computed tomography (CT) imaging. Clinical and procedural characteristics of the patients with and without AF recurrence were compared.

Results: Twenty-three (23%) patients had AF recurrence and 77 (77%) patients had no recurrence. The clinical parameters such as hypertension, diabetes mellitus, coronary artery disease and stroke did not differ between the groups. Left atrium diameter was significantly different between the two groups (4.1 ±0.5 vs. 3.9 ±0.5, = 0.042). Presence of LAD was not different between the two groups (7 (31.8) vs. 21 (28.8); = 0.794). Multivariate logistic regression analysis revealed RF ablation as the most important independent variable for AF recurrence (β = 3.115, < 0.001, OR = 22.526, 95% CI: 4.287-118.351).

Conclusions: The presence of left atrial diverticulum is not associated with recurrence in patients undergoing RF and cryoballoon CA for atrial fibrillation.