title: Prognostic implication of left atrial sphericity in atrial fibrillation patients undergoing radiofrequency catheter ablation.
abstract: BACKGROUND
  Left atrial (LA) sphericity can predict recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). We sought to reconfirm the prognostic role of atrial sphericity after RFCA of atrial fibrillation (AF), assess any relationship between the atrial pressure and sphericity, and determine the characteristics of the patients for whom atrial sphericity was most highly predictive.
  
  
  METHODS
  All 148 nonvalvular AF patients (57 ± 11 years, 121 men, 95 paroxysmal AF [PaAF]) who underwent RFCA were enrolled. The LA volume (LAV) was determined and LA sphericity assessed from three-dimensional computed tomographic images. The preprocedural mean LA pressure (mLAP) was measured.
  
  
  RESULTS
  After a 3-month blanking period, AF/atrial tachycardia (AT) recurrences within 1 year were documented in 38 patients (26%). Patients with recurrence had a greater LAV (124 ± 35 mL vs 151 ± 45 mL, P < 0.001) and LA sphericity (0.669 ± 0.040 vs 0.684 ± 0.038, P = 0.041). In patients with smaller LAs (LAV < 125 mL), LA sphericity predicted AF/AT recurrences (odds ratio [OR]: 1.030 [for each 0.001 increase], 95% confidence interval [CI]: 1.008-1.053, P = 0.007), whereas the LAV did not. In patients with larger LAs (LAV ≥ 125 mL), the LAV could predict recurrence (OR: 1.021, 95% CI: 1.001-1.041, P = 0.036), while the LA sphericity could not. The LA sphericity and mLAP are linearly correlated (r = 0.345, P < 0.022) in persistent AF, but not PaAF.
  
  
  CONCLUSIONS
  LA spherical change precedes severe LA enlargement in AF. It predicts 1-year AF/AT recurrence after RFCA and is more important than the LA size in patients with less severe LA enlargement.
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Republic of Korea.|Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jeonggeun
authors.initials: J
authors.lastname: Moon
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Republic of Korea.
authors.forename: Jongwook
authors.initials: J
authors.lastname: Yu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Boyoung
authors.identifier: http://orcid.org/0000-0001-9036-7225
authors.initials: B
authors.lastname: Joung
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: ablation; atrial fibrillation; left atrium; pressure; prognosis