title: The impact of left atrial size on long-term outcome of catheter ablation of chronic atrial fibrillation.
abstract: BACKGROUND
  The left atrial (LA) size is an important predictor of atrial fibrillation (AF) procedural termination and the long-term outcome. We sought to evaluate the long-term outcome in regard to the LA size and procedural termination.
  
  
  METHODS
  Eighty-seven consecutive chronic AF patients (72 males, 53 +/- 10 years) underwent 3D mapping (NavX) and ablation. A stepwise approach including circumferential pulmonary vein (PV) isolation, linear ablation, and continuous complex-fractionated electrogram (CFE) ablation (targeting fractionation intervals of < 50 ms). Electrical cardioversion was applied to those without any procedural termination. The freedom from AF was defined as the maintenance of sinus rhythm without the use of any class I or III antiarrhythmic drugs after the blanking period.
  
  
  RESULTS
  Among the 87 patients, all received a circumferential PV isolation, 93% a linear ablation, and 59% a continuous CFE ablation. Those with AF procedural termination (n = 30) had a better long-term outcome when compared with those without termination during a follow-up of 21 +/- 12 months. Moreover, a Kaplan-Meier analysis showed that in those with an LA diameter of less than 45 mm (n = 49), the freedom from AF rate was higher when procedural termination was achieved (P = 0.004). On the contrary, the outcome was comparable in those with an LA diameter of >or= 45 mm (n = 38), whether AF procedural termination occurred or not (P = 0.658).
  
  
  CONCLUSIONS
  AF procedural termination was related to the long-term success during chronic AF ablation, especially in those with an LA diameter of less than 45 mm. The favorable effect of termination decreased when the LA diameter was >or= 45 mm.
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Li-Wei
authors: LW
authors: Lo
authors: Yenn-Jiang
authors: YJ
authors: Lin
authors: Hsuan-Ming
authors: HM
authors: Tsao
authors: Shih-Lin
authors: SL
authors: Chang
authors: Ameya R
authors: AR
authors: Udyavar
authors: Yu-Feng
authors: YF
authors: Hu
authors: Kwo-Chang
authors: KC
authors: Ueng
authors: Wen-Chin
authors: WC
authors: Tsai
authors: Ta-Chun
authors: TC
authors: Tuan
authors: Chien-Jung
authors: CJ
authors: Chang
authors: Wei-Hua
authors: WH
authors: Tang
authors: Satoshi
authors: S
authors: Higa
authors: Ching-Tai
authors: CT
authors: Tai
authors: Shih-Ann
authors: SA
authors: Chen
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D016896:Treatment Outcome