title: Prognostic value of pulmonary vein size in prediction of atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study.
abstract: BACKGROUND
  The relationship between pulmonary vein (PV) anatomy and successful catheter ablation of atrial fibrillation (AF) is poorly understood
  
  
  METHODS
  First-pass contrast enhanced PV magnetic resonance angiography was performed in 71 consecutive patients prior to PV isolation. PV diameter and cross-sectional area (CSA) were measured prior to PV isolation. Any symptomatic or asymptomatic AF >10s was considered a recurrence. Early recurrence was defined as recurrent AF ≤30 days after PV isolation, while late recurrence of AF was defined as recurrent AF >30 days after.
  
  
  RESULTS
  At 1 year, 57% had any recurrence of AF while 41% had late recurrence of AF. Study subjects with one or more PV diameter in the top 10(th) percentile had trend toward more early recurrent AF (HR 1.99, p = 0.053). Study subjects with one or more PV CSA in the top 10th percentile had more late recurrent AF (HR 2.25, p = 0.039) and a trend toward more early recurrent AF (HR 1.94, p = 0.064). With multivariate analysis, PV size was not associated with early recurrent AF, but late recurrent AF was associated with one or more large PV, increased left atrial size, and non-paroxysmal AF. Study subjects with all three of these risk factors had a 100% rate of late recurrent AF at 1 year, while those with none had a 7% rate of late recurrent AF.
  
  
  CONCLUSIONS
  Larger PV size is independently associated with more late recurrent AF after PV isolation. Determination of PV size prior to PV isolation may predict procedural success.
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215, Massachusetts. thauser@bidmc.harvard.edu.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Hauser
authors.affiliation: Division of Cardiology, McGill University Health Center, Montreal, Canada. vidal.essebag@mcgill.ca.
authors.forename: Vidal
authors.initials: V
authors.lastname: Essebag
authors.affiliation: Azienda Ospedaliera Treviso, Treviso, Italy. dfbalde@tin.it.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Baldessin
authors.affiliation: Harbor Medical Associates, South Weymouth, Massachusetts. smcclennen@partners.org.
authors.forename: Seth
authors.initials: S
authors.lastname: McClennen
authors.forename: Susan B
authors.initials: SB
authors.lastname: Yeon
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215, Massachusetts. wmanning@bidmc.harvard.edu.|Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. wmanning@bidmc.harvard.edu.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215, Massachusetts. mjoseph2@bidmc.harvard.edu.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010690:Phlebography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome