title: Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation.
abstract: BACKGROUND
  Symptomatic left atrial (LA) flutter (LAFL) is common after atrial fibrillation (AF) ablation.
  
  
  OBJECTIVE
  The purpose of this study was to examine the association of baseline LA function with incident LAFL after AF ablation.
  
  
  METHODS
  The source cohort included 216 patients with cardiac magnetic resonance (CMR) before initial AF ablation between 2010 and 2013. Patients who underwent cryoballoon or laser ablation, patients with AF during CMR, and those with suboptimal CMR, or missing follow-up data were excluded. Baseline LA volume and function were assessed by feature-tracking CMR analysis.
  
  
  RESULTS
  The final cohort included 119 patients (mean age 58.9 ± 11 years; 76.5% men; 70.6% patients with paroxysmal AF). During a median follow-up of 421 days (interquartile range 235-751 days), 22 patients (18.5%) had incident LAFL. Baseline LA volume was similar between the 2 groups. In contrast, baseline reservoir, conduit, and contractile function of the LA were significantly impaired in patients with incident LAFL. Baseline global peak longitudinal atrial strain (PLAS) <22.65% predicted incident LAFL with 86% sensitivity and 68% specificity (C statistic 0.76). In a multivariable model adjusting for age, heart failure, and LA volume, PLAS (hazard ratio 0.9 per % increase in PLAS; P = .003) and LA linear lesions (hazard ratio 2.94; P = .020) were independently associated with incident LAFL. The coexistence of PLAS <22.65% and linear lesions was associated with 9-fold increased hazard of incident LAFL.
  
  
  CONCLUSIONS
  Baseline LA function and linear lesions were independently associated with incident LAFL after AF ablation. Linear lesions should be limited to selected cases, especially in patients with impaired LA function.
authors.affiliation: Departments of Cardiology.
authors.forename: Esra
authors.initials: E
authors.lastname: Gucuk Ipek
authors.affiliation: Departments of Cardiology.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Departments of Cardiology.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Habibi
authors.affiliation: Departments of Cardiology.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chrispin
authors.affiliation: Departments of Cardiology.
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.affiliation: Departments of Cardiology.
authors.forename: Jack
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Departments of Cardiology.
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.affiliation: Radiology, The Johns Hopkins University, School of Medicine.
authors.forename: Stefan L
authors.initials: SL
authors.lastname: Zimmerman
authors.affiliation: Biostatistics.
authors.forename: Vadim
authors.initials: V
authors.lastname: Zipunnikov
authors.affiliation: Departments of Cardiology.
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.affiliation: Departments of Cardiology.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Departments of Cardiology; Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: snazarian@jhmi.edu.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D003452:Cryosurgery / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D013223:Statistics as Topic
keywords: Atrial fibrillation; Atrial flutter; Cardiac magnetic resonance; Left atrium; Pulmonary vein isolation