Impact of right atrial structural remodeling on recurrence after ablation for atrial fibrillation. Issue 3 (6th May 2021)

• Record Type: Journal Article
• Authors: Takagi, Takahito; Nakamura, Keijiro; Asami, Masako; Toyoda, Yasutake; Enomoto, Yoshinari; Moroi, Masao; Noro, Mahito; Sugi, Kaoru; Nakamura, Masato
• Is Part Of: Journal of arrhythmia. Volume 37:Issue 3(2021)
• Page Start: 597
• Page End: 606
• Publication Date: 2021-05-06
• Subjects: arrhythmia recurrence -- atrial fibrillation -- catheter ablation -- left atrial remodeling -- right atrial remodeling; Arrhythmia -- Periodicals; Cardiac pacing -- Periodicals; Arrhythmias, Cardiac; Arrhythmia; Cardiac pacing; Periodicals; Electronic journals; Periodicals; 616.128
• DOI: 10.1002/joa3.12541
• Languages: English
• ISSNs: 1880-4276

Abstract

Abstract: Background: Recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) is associated with left atrial (LA) remodeling; however, its association with right atrial (RA) remodeling remains unclear. Objective: This study aimed to identify whether RA structural remodeling could predict recurrence of AF after PVI. Methods: This study prospectively analyzed 245 patients with AF who had undergone PVI. RA and LA volumes were determined by contrast‐enhanced computed tomography. Atrial structural remodeling was defined as an atrial volume of ≥110 mL according to previous reports and receiver operating characteristic curve analysis. Results: After excluding 32 patients, 213 patients were analyzed. During a follow‐up period of 12 months, 41 patients (19%) demonstrated atrial arrhythmia recurrence after PVI. With the Cox proportional‐hazards model, RA structural remodeling was the only predictor of arrhythmia recurrence (hazard ratio, 1.012; 95% confidence interval 1.003‐1.021; P = .009). Kaplan–Meier analysis showed that arrhythmia recurrence was more frequent in the RA structural remodeling group compared with the group without RA remodeling (log‐rank, P < .001), and the arrhythmia‐free survival rates in these groups at 12 months were 68.0% and 91.4%, respectively. Additionally, there was a significant difference in recurrence‐free survival after RA structural remodeling in each type of AF (log‐rank, P < .001). Conclusions: RA structural remodeling is a useful predictor of clinical outcome after PVI regardless of the type of AF. Our results suggest that patients without RA structural remodeling may be good candidates for successful ablation with PVI. Abstract : A greater incidence of recurrence was observed in the presence of RA structural remodeling regardless of the AF type. RA structural remodeling was a useful predictor of clinical outcomes after PVI.