title: Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes.
abstract: OBJECTIVE
  The association between anatomical left atrial (LA) remodelling and ventricular diastolic dysfunction (DD) in atrial fibrillation (AF) patients is not well studied. We aimed to examine the effect of DD on anatomic LA remodelling and their relation with ablation outcomes.
  
  
  RESULTS
  In 104 patients (58 ± 10 years, 69% male) referred for AF ablation, LA volume (LAV) was determined by computed tomography. A cutting plane, between the pulmonary vein (PV) ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA parts. The ratio of LA-A and LAV was defined as the LA asymmetry index (ASI). According to the current guidelines, the presence of DD was evaluated by echocardiography. Regression analysis was used to identify predictors of asymmetry changes and long-term success. Univariate linear regression revealed that ASI is associated with LAV, the presence of DD, and mitral regurgitation. Asymmetry index was higher in patients with DD (n = 35, 62 ± 5 vs. 59 ± 6%, P = 0.013) or mitral regurgitation (n = 67, 61 ± 6 vs. 58 ± 5%, P = 0.025). Multiple linear regression analysis showed that DD (B = 2.6, β = 0.207, 95% confidence interval, CI: 0.167-5.011, P = 0.036) and LAV (B = 0.037, β = 0.211, 95% CI: 0.003-0.071, P = 0.033) were the only factors independently associated with ASI (adjusted r2 = 0.92, F = 6.2, P = 0.003). Regression analysis showed that AF recurrence (33% after 24 months) is associated with asymmetric LA changes, while DD is not.
  
  
  CONCLUSIONS
  Left atrial symmetry changes are associated with DD and dilatation. Since DD could cause LA remodelling, appropriate early treatment should be considered for AF patients with DD, before geometrical changes occur.
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Koutalas
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Husser
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
authors.forename: Ole-Alexander
authors.initials: OA
authors.lastname: Breithardt
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D017115:Catheter Ablation / Q000009:adverse effects; D003971:Diastole; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left
keywords: Asymmetry index; Atrial fibrillation; Catheter ablation; Diastolic dysfunction; Echocardiography; Left atrial remodelling