Impact of Right Heart Chambers Abnormalities on Outcome after Ablation of Atrial Fibrillation with Second-Generation Cryo-Balloon

Background: The impact of enlarged left atrial size on maintenance and post ablation recurrence of atrial fibrillation is well known. The role of right atrial and right ventricular abnormalities on outcome after catheter ablation is not sufficiently investigated.

Purpose: Aim of this study was to analyze impact of reduced tricuspid annular plane systolic excursion (TAPSE) and increased size of right atrium in combination with other clinical parameters on outcome after pulmonary vein isolation (PVI) with 2^nd and 3^rd -generation cryo-balloon (CBA). Methods: Consecutive patients ablated since May 2012 were enrolled in the study. The primary endpoint of this study was the first documented recurrence>30 sec. All patients were followed prospectively with 7-day Holter ECG recordings every three months within 1^st year after the procedure and once in year thereafter.

Results: A total of 669 patients (male=421, pers.AF=246, median age (IQR) = 62 (54-69), history of AF = 2.25 (0.5-5.5) y, LA_= 20.52 (17.55-24.00) cm², RA=17.28 (14.72-20) cm², TAPSE= 24 (21-26) mm, CHADs2VASC score= 1.49 (1.38-1.60)) were followed up since May 2012. The value of 20 mm was set as cut-off of TAPSE. Within median follow up of 28 (11-36) months 393/524 (75.0%) of patients with TAPSE≥20 mm did not reach endpoint whereas 56/145 (38.6%) of patients with TAPSE2y (1.90 (1.30-2.79), LA>21cm² (1.63 (1.16-2.29) and TAPSE< 20 mm (2.41 (1.55-3.74) were revealed to be independent predictors after performing of multivariate Cox regression model. Right atrium was not revealed to be predictive Conclusion: Right ventricular dysfunction assessed by reduced TAPSE was revealed to be independent predictor for recurrence after PVI with CBA and should be considered by evaluation of patients with atrial fibrillation. Right atrial size was not revealed to be predictive in multi-variate analysis.