title: Left atrial sphericity: a new method to assess atrial remodeling. Impact on the outcome of atrial fibrillation ablation.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation outcome is mainly determined by atrial remodeling that, nowadays, is only estimated through clinical presentation (persistent vs. paroxysmal) and left atrial (LA) dimension. The aim of the study was to stage the atrial remodeling process using the Left Atrial Sphericity (LASP) and determine whether this technique may help to predict AF ablation outcome.
  
  
  METHODS
  Consecutive patients who underwent contrast-enhanced cardiac magnetic resonance angiography before AF ablation were included in the study. Three-dimensional reconstruction of LA excluding pulmonary veins and the LA appendage was used to define the LA cavity. The LASP was automatically obtained with self-customized software.
  
  
  RESULTS
  106 patients were included and categorized in 3 groups (Gs): discoid-LA (G1), intermediate-LA (G2), and spherical-LA (G3). The G3 patients had larger LA anteroposterior diameter than G1 and G2 patients (47 ± 7 vs 43 ± 6 and 39 ± 5 mm; P < 0.001), greater LA volume (90 ± 39 vs 86 ± 24 and 73 ± 20 mm; P = 0.012), and higher prevalence of persistent AF (75% vs 48% and 29%; P = 0.034) structural heart disease (75% vs 19% and 19%; P < 0.001), and AF recurrence at 12 months follow-up (58% vs 29% and 5%, P < 0.001). The LASP had linear correlation to predicted probability of recurrence. Multivariate analysis identified LASP (OR 1.320 [1.096-1.591], P = 0.004) and hypertension (OR 3.694 [1.282-10.645]; P = 0.016) as independent risk factors for arrhythmia recurrence.
  
  
  CONCLUSIONS
  Left Atrial Sphericity is a new independent predictor of recurrence after AF ablation and may be useful in selecting the best candidates for AF ablation.
authors.affiliation: Unitat de Fibril·lació Auricular, Servei de Cardiologia, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Bisbal
authors.forename: Esther
authors.initials: E
authors.lastname: Guiu
authors.forename: Naiara
authors.initials: N
authors.lastname: Calvo
authors.forename: David
authors.initials: D
authors.lastname: Marin
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Elena
authors.initials: E
authors.lastname: Arbelo
authors.forename: José
authors.initials: J
authors.lastname: Ortiz-Pérez
authors.forename: Teresa María
authors.initials: TM
authors.lastname: de Caralt
authors.forename: José María
authors.initials: JM
authors.lastname: Tolosana
authors.forename: Roger
authors.initials: R
authors.lastname: Borràs
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology* / Q000601:surgery*; D016275:Atrial Function; D057791:Cardiac Imaging Techniques / Q000379:methods; D017115:Catheter Ablation; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: atrial fibrillation; cardiac magnetic resonance; catheter ablation; left atrial sphericity; remodeling