title: Reversal of spherical remodelling of the left atrium after pulmonary vein isolation: incidence and predictors.
abstract: OBJECTIVE
  Pulmonary vein isolation (PVI) induces left atrial (LA) volume reduction, known as reverse remodelling (RR). The related changes in LA shape have not yet been evaluated. Left atrial sphericity (LASP) is a new shape-based marker of remodelling that compares LA geometry and a perfect sphere and is a powerful predictor of PVI success. We aimed to evaluate the effect of PVI on LASP and describe the concept of spherical and volumetric RR.
  
  
  RESULTS
  Left atrial sphericity and volume were automatically obtained with self-customized software using a magnetic resonance imaging-based three-dimensional reconstruction of LA. Reverse remodelling was defined as improvement in LASP (spherical RR) or volume reduction (volumetric RR). In a series of 102 patients, spherical and volumetric RR was observed in 42.2 and 69%, respectively. Patients with paroxysmal atrial fibrillation (AF) had higher probability to present spherical RR as compared with patients with persistent AF (50.8 vs. 29.3%, P = 0.03). Patients with persistent AF showed significant post-procedural worsening of LASP (81.9 vs. 82.9%, P = 0.04). Patients with no recurrence showed a trend towards a higher proportion of spherical RR compared with those with recurrences (46.2 vs. 32.4%, respectively); no differences were observed in volumetric RR (62.1 vs. 62.9%, respectively). Paroxysmal AF was the only independent predictor of spherical RR.
  
  
  CONCLUSIONS
  Pulmonary vein isolation leads to spherical RR in a substantial proportion of patients, and in higher proportion of patients with paroxysmal AF. Reverse remodelling may be caused by a combination of scarring and myocardial structural recovery. Changes in LASP might be more specific than volume reduction to detect favourable remodelling.
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Bisbal
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Guiu
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Cabanas
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain.
authors.forename: Naiara
authors.initials: N
authors.lastname: Calvo
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Tolosana
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Arbelo
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Vidal
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Teresa María
authors.initials: TM
authors.lastname: de Caralt
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain lmont@clinic.ub.es.
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D064752:Atrial Remodeling; D009202:Cardiomyopathies / Q000209:etiology* / Q000473:pathology* / Q000517:prevention & control; D017115:Catheter Ablation / Q000009:adverse effects*; D006325:Heart Atria / Q000473:pathology; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Atrial fibrillation; Atrial volume; Catheter ablation; Magnetic resonance; Remodelling; Spherical reverse remodelling