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Impact of left atrial fibrosis and left atrial size on the outcome of catheter ablation for atrial fibrillation
  1. Dennis W den Uijl,
  2. Victoria Delgado,
  3. Matteo Bertini,
  4. Laurens F Tops,
  5. Serge A Trines,
  6. Nico R van de Veire,
  7. Katja Zeppenfeld,
  8. Martin J Schalij,
  9. Jeroen J Bax
  1. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Jeroen J Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; j.j.bax{at}


Background Left atrial (LA) dilatation is an important risk factor for recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). However, the clinical applications to select patients eligible for RFCA according to LA size is limited. Additional pre-procedural assessment of LA fibrosis might improve patient selection for RFCA.

Objective To investigate the impact of LA size and LA fibrosis on the outcome of RFCA for AF.

Methods One hundred and seventy consecutive patients undergoing RFCA for AF were studied. LA size was assessed by measuring maximum LA volume index on echocardiography. LA wall ultrasound reflectivity was assessed by measuring echocardiography-derived calibrated integrated backscatter (IBS) as a surrogate of LA fibrosis.

Results After 12±3 months' follow-up, 103 patients (61%) had maintained sinus rhythm and 67 patients (39%) had recurrence of AF. Univariate Cox analyses identified LA wall ultrasound reflectivity, as well as LA size and type of AF, as predictors of AF recurrence after RFCA. Importantly, multivariate analyses showed that LA wall ultrasound reflectivity remained a strong predictor after correction for LA size and type of AF. Moreover, LA wall ultrasound reflectivity provided an incremental value in predicting outcome of RFCA over LA size and type of AF (increment in global χ2=61.6, p<0.001).

Conclusion Assessment of LA fibrosis using two-dimensional echocardiography-derived calibrated IBS can be useful to predict AF recurrence after RFCA. Combined assessment of LA wall ultrasound reflectivity and LA size improves the identification of patients with a high likelihood for a successful ablation.

  • Atrial fibrillation
  • ablation
  • echocardiography
  • left atrial fibrosis
  • left atrial size
  • radiofrequency ablation
  • cardiac remodelling

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  • Funding MJS receives research grants from Boston Scientific, Medtronic and Biotronik. JJB receives research grants from General Electric Healthcare, Bristol-Myers Squibb Medical Imaging, St Jude, Medtronic, Boston Scientific, Biotronik, and Edwards Lifesciences.

  • Competing interests None to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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