title: Impact of atrial remodeling on the outcome of radiofrequency catheter ablation of paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Both the left atrial volume index (LAVI) and estimated total atrial conduction time measured using tissue Doppler imaging of the atria (PA-TDI duration) are echocardiographic parameters reflecting atrial remodeling. We investigated their prognostic value for atrial tachyarrhythmia (AF/AT) recurrence after radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation (PAF).
  
  
  RESULTS
  We analyzed the data for 100 consecutive patients with drug-refractory PAF who underwent RFCA. The correlation between the LAVI and PA-TDI was extremely weak (r=0.26, P<0.01). We categorized the patients into 4 groups based on the median LAVI and PA-TDI duration: group 1 (LAVI <29ml/m(2)/PA-TDI duration <143ms), group 2 (LAVI ≥29ml/m(2)/PA-TDI duration <143ms), group 3 (LAVI <29ml/m(2)/PA-TDI duration ≥143ms), and group 4 (LAVI ≥29ml/m(2)/PA-TDI duration ≥143ms). With a mean follow-up of 20.2±8.9 months after a single RFCA procedure, 60 patients (60%) were in sinus rhythm without any antiarrhythmic drugs. Multivariate analysis using a Cox proportional hazards model demonstrated that the group was an independent predictor of AF/AT recurrence after RFCA (P=0.0017). The patients in groups 2, 3, and 4 had a 4.0-fold (P=0.048), 6.8-fold (P=0.0034) and 10.9-fold (P=0.0001) increase, respectively, in the probability of recurrent AF/AT as compared with group 1.
  
  
  CONCLUSIONS
  Preprocedural echocardiographic estimation of atrial remodeling was a useful predictor of AF/AT recurrence following a single RFCA of PAF.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ejima
authors.forename: Ken
authors.initials: K
authors.lastname: Kato
authors.forename: Kotaro
authors.initials: K
authors.lastname: Arai
authors.forename: Keiko
authors.initials: K
authors.lastname: Fukushima
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Fukushima
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshida
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nuki
authors.forename: Shoko
authors.initials: S
authors.lastname: Uematsu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hoshi
authors.forename: Tetsuyuki
authors.initials: T
authors.lastname: Manaka
authors.forename: Kyomi
authors.initials: K
authors.lastname: Ashihara
authors.forename: Morio
authors.initials: M
authors.lastname: Shoda
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D064752:Atrial Remodeling; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013610:Tachycardia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014463:Ultrasonography