Persistent left atrial remodeling after catheter ablation for non-paroxysmal atrial fibrillation is associated with very late recurrence

Background: This study aimed to evaluate the association between left atrial (LA) structural remodeling and very late recurrence [VLR; initial recurrence >12 months after catheter ablation (CA)] after successful CA for non-paroxysmal atrial fibrillation (AF). Methods: We retrospectively evaluated 63 patients who underwent initial, single ablation for drugrefractory persistent or long-standing persistent AF and those who had no recurrence in the first year after CA. We followed patients for a mean of 3.2 +/- 1.5 years and divided them into VLR and no-recurrence (NR) groups. Before and 3 months after ablation, all patients were subjected to 64-slice multidetector computed tomography scanning to estimate LA volume, including maximum and minimum volume during the cardiac cycle (LAMaxV and LAMinV, respectively), and the LA emptying fraction. Results: VLR occurred in 21 patients. The reduction rate of LAMaxV after CA was significantly larger in the NR group than in the VLR group (25 +/- 19% vs. 5 +/- 18%, p = 0.0002). Receiver operating characteristic analysis was performed to determine the best cut-off values in the prediction of VLR. The highest area-under curve was obtained with post-CA LAMinV [0.828 (95% confidence interval, 0.712-0.912), p < 0.0001], with a best cut-off value of 44 mL (sensitivity 81.0%, specificity 81.0%). Conclusions: Persistent LA structural remodeling after initially successful CA for non-paroxysmal AF may be an important risk factor for VLR. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.