title: Reverse atrial remodeling following pulmonary vein isolation: the importance of the body mass index.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) causes a reduction in left atrium size that is attributable to reverse atrial remodeling (RAR). The objective of this study was to identify predictors of RAR and determine its association with other parameters of improvement in cardiac function.
  
  
  METHODS
  It is a prospective study with 74 patients (52 ± 9 years old, 81% male), and 51% of patients had paroxysmal atrial fibrillation. Patients were serially assessed with transthoracic echocardiography; plasma N-terminal B-type natriuretic peptide (NT-proBNP); and high-sensitivity C-reactive protein levels at baseline and 3, 6, and 12 months following the PVI. RAR was defined as a reduction in the left atrial volume index (LAV-index) >10% from baseline at the end of follow-up. A multivariate analysis was conducted to identify predictors of RAR.
  
  
  RESULTS
  The LAV-index decreased significantly during follow-up in the entire population (P = 0.0005). RAR (experienced by 63.5% of the patients) was more frequent (76% vs. 42%; P = 0.004) and pronounced (reduction 16.65 ± 14% vs. 8 ± 14%; P = 0.015) in patients with a successful ablation (46 of 74 patients, 62.2%). Only patients with RAR showed significant improvement in NT-proBNP levels (P = 0.0001), systolic function (P = 0.035), and diastolic function (P = 0.005). Multivariable analysis revealed that a successful ablation (odds ratio [OR] = 4.6; 95% confidence interval [CI] 1.46-14.68; P = 0.009), LAV-index (OR = 1.15; 95% CI 1.03-1.2; P = 0.021), and patient's body mass index (OR = 0.84; 95% CI 0.74-0.96; P = 0.012) were independent predictors of RAR.
  
  
  CONCLUSIONS
  Successful PVI ablation is the main predictor of RAR that is associated with other parameters of improvement in cardiac function. The patient's body mass index may have a negative effect on RAR.
authors.affiliation: Arrhythmia Unit, Department of Cardiology, Hospital Universitario Virgen del Rocío, Seville, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arana-Rueda
authors.forename: Alonso
authors.initials: A
authors.lastname: Pedrote
authors.forename: Lorena
authors.initials: L
authors.lastname: García-Riesco
authors.forename: Alvaro
authors.initials: A
authors.lastname: Arce-León
authors.forename: Federico
authors.initials: F
authors.lastname: Gómez-Pulido
authors.forename: Juan-Manuel
authors.initials: JM
authors.lastname: Durán-Guerrero
authors.forename: Agustín
authors.initials: A
authors.lastname: Fernández-Cisnal
authors.forename: Manuel
authors.initials: M
authors.lastname: Frutos-López
authors.forename: Juan-Antonio
authors.initials: JA
authors.lastname: Sánchez-Brotons
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D064752:Atrial Remodeling; D015992:Body Mass Index; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: ablation; atrial fibrillation; echocardiography; electrophysiology - clinical