Left atrioventricular coupling index assessed by cardiac CT as a predictive marker for atrial fibrillation recurrence after ablation

TL;DR

This study shows that the left atrioventricular coupling index, measured via cardiac CT, can predict whether atrial fibrillation will return after ablation treatment.

Contribution

The study demonstrates that LACI is a superior predictor of AF recurrence compared to traditional metrics.

Findings

29.2% of patients experienced AF recurrence within 18 months after ablation.

LACI was a strong independent predictor of recurrence with an odds ratio of 9.51.

LACI showed better predictive accuracy than the left atrial volume index.

Abstract

The left atrioventricular coupling index (LACI) is a significant predictor of cardiovascular events, heart failure, and atrial fibrillation (AF). However, its predictive efficacy for AF recurrence after ablation remains underexplored.

This study aimed to evaluate the predictive value of LACI, assessed by cardiac computed tomography (CT), for AF recurrence following ablation.

We performed a retrospective analysis of 130 AF patients who underwent cardiac CT before ablation at our institution from January 2019 to March 2021. LACI, defined as the ratio of left atrial to left ventricular volume during diastole, was analyzed using multivariate binary logistic regression to determine its association with AF recurrence. Kaplan–Meier survival curves assessed the duration of asymptomatic survival post-ablation.

At 18 months, 29.2% (38/130) of patients experienced recurrence. Patients with recurrence had significantly higher LACI compared to those without (129.56 ± 48.02% vs. 84.58 ± 28.78%, P < 0.001). Multivariate analysis identified LACI as an independent risk factor for recurrence (OR = 9.51, 95% CI 1.99–45.34, P = 0.005), showing superior predictive capacity compared to the left atrial volume index (AUC: 0.815 vs. 0.779, P < 0.001). Kaplan–Meier curves demonstrated significantly lower cumulative AF recurrence-free survival in patients with LACI ≥ 89%.

LACI is a strong and independent predictor of AF recurrence post-ablation, offering superior risk discrimination over traditional left atrial and left ventricular parameters, thereby enhancing the clinical utility of cardiac CT before AF ablation.

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