الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
trial fibrillation (AF) is the most common cardiac arrhythmia with a projected prevalence of about 16 million by the year 2050. AF leads to thromboembolic strokes, myocardial infarction and heart failure, and is associated with increased mortality, costing the US health care system an approximate 6 billion dollars a year (Mozaffarian et al., 2015).
Pulmonary vein isolation (PVI) by radiofrequency ablation (RFA) is now an established therapeutic option for AF and is commonly used in patients with symptomatic AF who have failed anti-arrhythmic drug therapy, With a rate of success after pulmonary vein isolation varies between 50– 80% (Calkins et al., 2012), 50% and 60% for persistent AF and 60% and 80%, for paroxysmal AF depening on ablation stretegies (Garvanski et al., 2019; Ganesan et al., 2013; Steven et al., 2013).
Therefore, assessing the risk of individual recurrence is important for optimizing the benefits of catheter ablation and selecting appropriate patients, which helps to identify those patients who are most likely to benefit from AF ablation (Okada et al., 2021; Verma et al., 2015; Bergonti et al., 2023).
The aim of this study is to assess left atrial volume in atrial fibrillation patients using non-Invasive echocardiography and invasive 3D mapping (CARTO) and its predictive value in recurrence of atrial fibrillation after ablation.
The study was conducted on 42 consecutive patients with Non-valvular AF who underwent Pulmonary vein isolation and came to follow up in the outpatient clinic in the Cardiology Department at El Galaa Military hospital and Benha University hospital were enrolled. Recruitment started in January 2022 and ended in July 2023.
All study population underwent Trans-Thoracic Echocardiography, before AF ablation procedure.
It included patients with Non-valvular paroxysmal or persistant AF.
Patients were excluded from the study if they had any of the following: (Kranert et al., 2020; Xue et al., 2017).
Valvular AF, Patients with structural heart disease, chronic AF patients, Acute myocardial infarction, Cardiogenic shock, Indication for aortocoronary bypass operation, Acute stroke and Uncontrolled hypertension with systolic blood pressure >160 mmHg.
All study population underwent history taking, clinical examination to assess AF type and medical history, height and weight to calculate BMI and BSA using Mosteller equation (Havranek et al., 2016; Liu et al., 2023).
ECG or Holter (Kranert et al., 2020).
Echocardiographic and Doppler studies: Transthoracic echocardiography (TTE). Two dimensional images were obtained in the standard parasternal and apical views. Ejection fractions (EF) were performed using the biplane Simpson’s method. (Kranert et al., 2020; Gottdiener et al., 2004; Abhayaratna et al., 2006; Lang et al., 2014). (Fig.13)
Left atrial (LA) volumes were measured using Simpson method in apical 4-chamber and apical 2-chamber views at ventricular end systole (maximum LA size): 20 discs obtained from orthogonal views (Jiamsripong et al., 2008).
LAVI was obtained by indexing the LA volume to the body surface area (BSA) (Kranert et al., 2020).
AF ablation procedure was done using CARTO 3 (Biosense Webster, CA, USA) version 4, 3D virtual map Anatomical construction of the LA was done by software interpolations over the co-ordinates of multiple endocardial tags. LAV (left atrial volume) CARTO was calculated using a built-in computational function of the Biosense software, the volume of pulmonary veins and LA appendage were excluded (Havranek et al., 2016).
Continuing anti arrhythmic drugs treatment for 6 weeks to 3 months may reduce early AF recurrences (Kaitani et al., 2016; Roux et al., 2009; Potpara et al., 2020).
Patients were monitored for procedure-related complications including tamponade and/or pericardial effusion, thromboembolic events, and bleeding event.
Patient follow up was done at 1, 3 and 6 months after the procedure to detect AF recurrence.
Systemic anticoagulation with warfarin or a NOAC is continued for at least 2 months post ablation, and Long-term continuation of systemic anticoagulation beyond 2 months post ablation is based on the patient’s stroke risk profile CHA2DS2-VASc stroke risk factors rather than the rhythm status and the apparent success or failure of the ablation procedure.
We found that Left atrial volume (LAV) measured by CARTO was significantly higher compared to LAV measured by Echocardiography.
And found that recurrence rate after AF ablation was significantly higher in patients with LAVI more than 36ml/m2 (47.8%) than patients with LAVI less than 36ml/m2 (5.3%).
Another finding in our study that LAV by CARTO can significantly predict the AF recurrence with cutoff value of >98 ml.
An observation in our study is that we had 75% of Early recurrence ERAF cases had late recurrence, and our results were near consistent with Kim et al. (2021) and Xue et al. (2017) and Nalliah et al. (2015).
We also found that high Body Mass Index (BMI) related significantly with the recurrence of AF after AF ablation.
We noticed that Recurrence was significantly lower in patients with ablation catheter type Thermo Cool Smart Touch (contact force catheter) (11.1%) than patients with EZ steer (non contact force catheter) (41.7%).