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Associations between the atrial electromechanical interval, atrial remodelling and outcome of catheter ablation in paroxysmal atrial fibrillation
  1. Tze-Fan Chao1,2,
  2. Shih-Hsien Sung1,2,
  3. Kang-Ling Wang1,2,
  4. Yenn-Jiang Lin1,2,
  5. Shih-Lin Chang1,2,
  6. Li-Wei Lo1,2,
  7. Yu-Feng Hu1,2,
  8. Ta-Chuan Tuan1,2,
  9. Kazuyoshi Suenari1,3,
  10. Cheng-Hung Li1,2,
  11. Kuo-Chang Ueng4,
  12. Tsu-Juey Wu5,
  13. Shih-Ann Chen1,2
  1. 1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taiwan
  3. 3Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
  4. 4Division of Cardiology and Cardiovascular Surgery, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  5. 5Division of Cardiology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
  1. Correspondence to Dr Shih-Ann Chen, Division of Cardiology, Veterans General Hospital-Taipei 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan; epsachen{at}


Objective The atrial electromechanical (PA–PDI) interval was reported to be a useful predictor of new-onset atrial fibrillation (AF) and the occurrence of AF after coronary artery bypass surgery. The aim of this study was to investigate the associations of the electromechanical interval with atrial substrate properties and the outcome of catheter ablation in paroxysmal AF patients.

Methods 132 paroxysmal AF patients who had received catheter ablation were enrolled. The electromechanical interval was determined as the time interval from the initiation of P-wave deflection to the peak of the mitral inflow A-wave on pulse-wave Doppler imaging. The left atrial voltage and total activation time were collected before pulmonary vein isolation. Every patient underwent standard follow-up after catheter ablation.

Results The PA–PDI interval was significantly correlated with the left atrial dimension (r=0.419, p=0.003), left atrial volume (r=0.827, p<0.001), left atrial voltage (r=−0.451, p<0.001) and left atrial activation time (r=0.547, p<0.001). During a follow-up of 23±13 months, 36 patients (27% of the study population) had AF recurrence. The PA–PDI interval and left atrial volume were independent predictors of AF recurrence. At a cut-point of 160 ms, the Kaplan–Meier survival analysis showed that a long PA–PDI interval significantly predicted AF recurrence.

Conclusions The PA–PDI interval can reflect the process of left atrial remodelling, such as a left atrial enlargement, prolonged activation time and decreased voltage. It was a convenient parameter for predicting recurrence after catheter ablation of paroxysmal AF.

  • Atrial fibrillation
  • cardiac remodelling
  • catheter ablation
  • electromechanical interval
  • radiofrequency ablation (RFA)

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  • Funding This work was supported by intramural grants (V96C1-049, V97C1-059, V98C1-037 and V99C1-120) from Taipei Veterans General Hospital, Taiwan, and grants (NSC95-2314-B-010-017, NSC95-2314-B-010-025, NSC96-2314-B-010-006, NSC96-2628-B-010-036, NSC97-2314-B-010-037-MY3, NSC97-2314-B-010-038, NSC98-2314-B-010-031-MY3) from the National Science Council, Taiwan.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Taipei Veterans General Hospital.

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