title: Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation.
abstract: BACKGROUND
  Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). However, the assessment of anatomical information and predictors of AF recurrence remain unclear. We investigated the relationship between anatomical information on the left atrium (LA) and pulmonary veins (PVs) from three-dimensional computed tomography images and the recurrence of AF after CA.
  
  
  METHODS
  Sixty-seven consecutive AF patients (mean age: 62±10 years, median AF history: 42 (12; 60) months, mean LA size: 41±7 mm, paroxysmal: 56%) underwent CA and were followed for 19±10 months. The segmented surface areas (antral, posterior, septal, and lateral) and dimensions (between the anterior and posterior walls, the right inferior PV and mitral annulus [MA], the right superior PV and MA, the left superior PV and MA, and the mitral isthmus) of the LA were evaluated three dimensionally using the NavX system. The cross-sectional areas of the PVs were also evaluated.
  
  
  RESULTS
  After the follow-up period, 49 patients (73%) remained free from AF. A multivariate analysis showed that the diameter of the mitral isthmus and cross-sectional area of the right upper PV were associated with AF recurrence (odds ratio: 1.070, CI: 1.02-1.12, p=0.001; odds ratio: 0.41, CI: 0.21-0.77, p=0.006).
  
  
  CONCLUSIONS
  Enlargement of the mitral isthmus and a smaller right superior PV cross-sectional area were associated with AF recurrence.
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Kiuchi
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Asumi
authors.initials: A
authors.lastname: Takei
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fukuzawa
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Itoh
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Kimitake
authors.initials: K
authors.lastname: Imamura
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Ryudo
authors.initials: R
authors.lastname: Fujiwara
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan.
authors.forename: Gaku
authors.initials: G
authors.lastname: Kanda
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Okajima
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimane
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan.
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Yasaka
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kawai
keywords: 3D-CT, three-dimensional computed tomography; AF, atrial fibrillation; Atrial fibrillation; Catheter ablation; Computed tomography; LA, left atrium; Left atrium; MA, mitral annulus; PV, pulmonary vein; Pulmonary vein