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Right Atrial Volume is Superior to Left Atrial Volume for Prediction of Atrial Fibrillation Recurrence Post DC Cardioversion


Journal Article

Luong, C.; Thompson, D.J.S.; Bennett, M.; Gin, K.; Jue, J.; Barnes, M.E.; Colley, P.; Tsang, T.

Canadian Journal of Cardiology


Background The value of right atrial (RA) volume as a predictor for recurrence of atrial fibrillation (AF) following direct current cardioversion (DCCV) is unknown. Methods We sought to compare the performance of RA volume indexed to body surface area (RAVI), left atrial diameter (LAd), LAVI, and biatrial volume index (BAVI) for the prediction of AF recurrence at 6 months post DCCV. This study included the first 95 consecutive patients from the AF Clinic at a large tertiary care hospital who underwent DCCV and who had an echocardiogram available within 6 months prior to DCCV. Maximal LAVI, RAVI, and BAVI were determined from pre-DCCV echocardiogram. ECG and clinical data were acquired at baseline, pre-cardioversion, and at each clinic visit. Results Of the 95 patients (64 male; mean age 63±12 years), history of systemic hypertension, diabetes mellitus, heart failure, and transient ischemic attack/stroke was present in 60 (63%), 14 (15%), 27 (28%), and 5 (5%) patients, respectively. Mean duration from AF diagnosis to DCCV was 3.5±5.0 years. At 6 months post-DCCV, 53 (56%) had reverted to AF. RAVI had superior predictive ability (area under the receiver operator characteristic curve: RAVI 0.77, LAd 0.54, LAVI 0.64, and BAVI 0.70). RAVI ≥ 42 ml/m2 provided the best accuracy for prediction of recurrence [76% accuracy, 71% sensitivity, 83% specificity, 90% positive predictive valve (PPV), and 56% negative predictive value (NPV)]. Best accuracy for LAVI was ≥48 ml/m2 (70% accuracy, 53% sensitivity, 79% specificity, 85% PPV; 43% NPV). Conclusion RAVI is superior to LAVI for the prediction of AF recurrence at 6 months post-DCCV.

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