title: A Thin Left Atrial Antral Wall Around the Pulmonary Vein Reflects Structural Remodeling by Atrial Fibrillation and is Associated with Stroke.
abstract: OBJECTIVE
  Circumferential pulmonary (PV) vein isolation (CPVI) is the most important treatment strategy for atrial fibrillation (AF). While understanding left atrial wall thickness around PVs (PVWT) prior to catheter ablation is important, its clinical implications are not known. This study aimed to evaluate PVWT characteristics according to underlying disease and to identify associations between PVWT and reconnections of PV potentials (PVPs) in redo ablation.
  
  
  METHODS
  In 28 patients who underwent redo-AF ablation, PVWT and reconnected PVPs were evaluated at 12 sites (1-12 o'clock) around each PV. Clinical characteristics including stroke and CHA₂DS₂-VASc scores were analyzed according to the PVWT.
  
  
  RESULTS
  The PVWT was thicker in males than females (p<0.001) and in those with diabetes (p=0.045) or heart failure (p=0.002) than in those without. Patients with strokes or high CHA₂DS₂-VASc scores (≥3) had significantly thinner PVWTs than those without strokes or low CHA₂DS₂-VASc scores (p<0.001). In redo-ablation, reconnected PVPs were detected in 60 (53.6%) of 112 PVs, and the PVs were thicker (p<0.001) and had more reconnected PVs (p=0.009) than right PVs. A PVWT of >0.6 mm predicted PV reconnections with a sensitivity of 76.7% and specificity of 52.2% with an area under the curve of 0.695.
  
  
  CONCLUSIONS
  Thick PVWs were associated with diabetes and heart failure, and also showed significant inverse correlations with stroke and the CHA₂DS₂-VASc score. Thick PVWs were associated with reconnected PVPs after the CPVI, which were related to AF recurrence.
authors.affiliation: Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Junbeom
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chul Hwan
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors.forename: Jae Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors.forename: Hui Nam
authors.initials: HN
authors.lastname: Pak
authors.affiliation: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors.forename: Moon Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Yonsei University Health System, Seoul, Korea. cby6908@yuhs.ac.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery*; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Pulmonary vein; ablation; reconnection; stroke; wall thickness