Minimum Left Atrial Volume Evaluated by 3D Echocardiography Predicts Atrial Fibrillation Recurrences After a First Radiofrequency Catheter Ablation for Paroxysmal Episodes.

Concomitant atrial fibrillation (AF) in non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients complicates the decision-making process regarding short- and long-term antithrombotic strategies. Patient profiles and usage rates of different antithrombotic combinations in this patient subgroup in Romania are poorly described. To evaluate the relationship between LA dimensions and AF recurrences (AFR) using echocardiography. We enrolled 40 patients (56 ± 10 years; 73% males) who underwent a first RFCA for paroxysmal AF. Bi- (2DE) and three-dimensional (3DE) echocardiography was performed prior to RFCA and at 12-months follow-up. Rhythm control was monitored for up to two years after the intervention by periodic ECG Holter monitoring. Atrial fibrillation recurrences were recorded in 21 patients (52%) in the first year after RCFA. The only predictor of outcome from pre-ablation LA parameters was 3DE minimum LAVi (p = 0.042), that explained 21.4% of AF recurrences in the first year, with a cut-off value of 21.29 mL/m². The mean 3DE min LAVi was 24.29 ± 8.01 mL/ m² and patients without AFR in the first year had a lower LAVi than those with AFR (20.92 ± 6.19 mL/m² vs. 27.25 ± 8.43 mL/m², p=0.028). One year after RFCA, a decrease in medio-lateral, superior-inferior diameters and volumes were recorded in AF free patients. Eleven patients (27%) had AF recurrences after the first year and LAV 12-months after RFCA were found to be predictors of long-term outcome, with minimum LAVi as the strongest predictor of recurrences (p=0.014), explaining 36% of episodes, with a cut-off over 22.49 mL/m². Radiofrequency ablation controls LA remodeling in patients with clinical success in terms of AF freedom. Left atrium 3DE volumetry is accurate in predicting RFCA outcome.