title: Persistent left atrial remodeling after catheter ablation for non-paroxysmal atrial fibrillation is associated with very late recurrence.
abstract: BACKGROUND
  This study aimed to evaluate the association between left atrial (LA) structural remodeling and very late recurrence [VLR; initial recurrence >12 months after catheter ablation (CA)] after successful CA for non-paroxysmal atrial fibrillation (AF).
  
  
  METHODS
  We retrospectively evaluated 63 patients who underwent initial, single ablation for drug-refractory persistent or long-standing persistent AF and those who had no recurrence in the first year after CA. We followed patients for a mean of 3.2±1.5 years and divided them into VLR and no-recurrence (NR) groups. Before and 3 months after ablation, all patients were subjected to 64-slice multidetector computed tomography scanning to estimate LA volume, including maximum and minimum volume during the cardiac cycle (LAMaxV and LAMinV, respectively), and the LA emptying fraction.
  
  
  RESULTS
  VLR occurred in 21 patients. The reduction rate of LAMaxV after CA was significantly larger in the NR group than in the VLR group (25±19% vs. 5±18%, p=0.0002). Receiver operating characteristic analysis was performed to determine the best cut-off values in the prediction of VLR. The highest area-under curve was obtained with post-CA LAMinV [0.828 (95% confidence interval, 0.712-0.912), p<0.0001], with a best cut-off value of 44mL (sensitivity 81.0%, specificity 81.0%).
  
  
  CONCLUSIONS
  Persistent LA structural remodeling after initially successful CA for non-paroxysmal AF may be an important risk factor for VLR.
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Yohei
authors: Y
authors: Sotomi
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan. Electronic address: koichi@inoue.name.
authors: Koichi
authors: K
authors: Inoue
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Koji
authors: K
authors: Tanaka
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Yuko
authors: Y
authors: Toyoshima
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Takafumi
authors: T
authors: Oka
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Nobuaki
authors: N
authors: Tanaka
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Yoichi
authors: Y
authors: Nozato
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Yoshiyuki
authors: Y
authors: Orihara
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Yasushi
authors: Y
authors: Koyama
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Katsuomi
authors: K
authors: Iwakura
authors: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 1-1, Yamadaoka, Suita, Osaka, Japan.
authors: Yasushi
authors: Y
authors: Sakata
authors: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors: Kenshi
authors: K
authors: Fujii
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology*; D064752:Atrial Remodeling / Q000502:physiology*; D002306:Cardiac Volume / Q000502:physiology; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Atrial fibrillation; Catheter ablation; Reverse remodeling; Very late recurrence