Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective Randomized Study Catheter ablation of atrial fibrillation in patients with atrial septal defect: long-term follow-up results Left atrial strain as predictor of successful outcomes in catheter ablation for atrial fibrillation: a two-dimensional myocardial imaging study Left atrial mechanics predict the success of pulmonary vein isolation in patients with atrial fibrillation Reverse Remodeling of the Left Cardiac Chambers After Catheter Ablation After 1 Year in a Series of Patients With Isolated Atrial Fibrillation Cardiac Magnetic Resonance–Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis) Repeated catheter ablation of atrial fibrillation: how to predict outcome? Symptomatic and asymptomatic atrial fibrillation after pulmonary vein ablation and the impact on quality of life. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation Circumferential Pulmonary Vein Ablation With Additional Linear Ablation Results in an Increased Incidence of Left Atrial Flutter Compared With Segmental Pulmonary Vein Isolation as an Initial Approach to Ablation of Paroxysmal Atrial Fibrillation Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons > or = 65 years of age. A prospective, multicenter evaluation of ablating complex fractionated electrograms (CFEs) during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy. Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Randomized Study Comparing Combined Pulmonary Vein–Left Atrial Junction Disconnection and Cavotricuspid Isthmus Ablation Versus Pulmonary Vein–Left Atrial Junction Disconnection Alone in Patients Presenting With Typical Atrial Flutter and Atrial Fibrillation Relationship between left atrial volume and atrial fibrillation following coronary artery bypass grafting. Is Pulmonary Vein Isolation Necessary for Curing Atrial Fibrillation?
Background —Ablation of the pulmonary veins ( PVs ) for atrial fibrillation treatment is often combined with linear radiofrequency lesions along the left atrium ( LA ) to improve the success rate . The study was design ed to assess the contribution of LA posterior wall isolation to the outcome of circumferential pulmonary vein ablation ( CPVA ) . Methods and Results —CPVA consisted of continuous radiofrequency lesions encircling both ipsilateral PVs plus an ablation line along the mitral isthmus . Patients were then r and omized into 2 groups . In the first group , superior PVs were connected by linear lesions along the LA roof ( CPVA-1 group ) . In the second group , the LA posterior wall was isolated by adding a second line connecting the inferior aspect of the 2 inferior PVs ( CPVA-2 group ) . The study included 120 patients ( 53±11 years , 77 % male , 60 % paroxysmal atrial fibrillation , LA of 41.3±5.4 mm , 46 % with hypertension , and 22 % with structural heart disease ) . After a single ablation procedure and a mean follow-up of 10±4 months , 24 ( 40 % ) patients of the CPVA-1 group had atrial fibrillation recurrences and 3 ( 5 % ) had new-onset LA flutter . In the CPVA-2  group , recurrences were due to atrial fibrillation episodes in 23 patients ( 38 % ) and LA flutter in 4 ( 7 % ) . Freedom from arrhythmia recurrences was not statistically different in the CPVA-1 group as compared with the CPVA-2 group ( log rank P=0.943 ) . Conclusion —Isolation of the LA posterior wall did not increase the success rate of CPVA Introduction Atrial fibrillation ( AF ) is commonly found in patients with structural heart disease ( SHD ) , including atrial septal defect ( ASD ) . The feasibility and safety of ablation for AF in patients with unrepaired ASD is seldom reported . Objectives This study aims to evaluate and compare the long-term efficacy of  AF ablation  in patients with and without ASD . Methods From January 2008 to December 2012 , 18 consecutive patients were identified with medically refractory AF and an unrepaired ASD under catheter ablation .  For each ASD patient , four control subjects were matched from our data base . Results There were no significant differences between groups in terms of age , sex , type of AF , LA diameter , LVIDD , and EF . The mean procedural and fluoroscopy times were not different between the groups ( p = NS ) . After a median follow-up of 20 months , the patients in the ASD group had 44.4 % AF recurrence after a single procedure compared with 34.7 % in the control group ( p = 0.11 ) . The mean LA diameter in non-recurrent patients was smaller than in recurrent patients ( p = 0.03 ) . In univariate Cox proportional hazards analyses , the factor found to have a significant association with arrhythmia recurrences was left atrial diameter ( hazard ratio 1.059 , 95 % confidence interval 1.002 to 1.120 , p = 0.03 ) . Conclusions These results indicate that in patients with AF and an ASD amenable to percutaneous closure , a staged approach with radiofrequency ablation of AF preceding closure is a rational strategy Background The objective of this study was to investigate atrial myocardial properties through two-dimensional ( 2D ) myocardial imaging in patients with atrial fibrillation ( AF ) and its predictive role for recurrence after catheter ablation . Methods and results Echocardiographic examinations were performed in 40 patients with paroxysmal AF before catheter ablation and 40 age- and gender-matched healthy control subjects . Using a software package , bidimensional acquisitions were analyzed to measure longitudinal strain and strain rate for the left atrium ( LA ) . Systolic strain and strain rate in all eight segments , and its average values , were significantly reduced in AF patients compared to controls . During 9 months of follow-up after catheter ablation for AF , 11 of 40 AF patients had AF recurrence . AF recurrence was associated with gender , LA volume index , and average values of systolic strain and strain rate . By multivariate analysis , only average strain was an independent predictor of AF recurrence ( OR = 0.88 , 95 % CI 0.79 - 0.98 , p = 0.018 ) . Conclusions Lower systolic strain of LA was strongly associated with recurrence after catheter ablation . Thus , diverse adjunctive ablation strategies should be considered to reduce recurrence in patients with lower systolic strain Background Atrial fibrillation ( AF ) is a common arrhythmia with relevant impact on mortality and morbidity .  Pulmonary vein isolation ( PVI ) is an established therapy in patients who remain symptomatic under optimal medical therapy . However , up to 70 % of patients present with recurrence of AF after PVI . Therefore , identifying ideal c and i date s is an unmet clinical need . Left atrial ( LA ) fibrosis is associated with reduced LA function . Analysis of LA mechanics using 2D speckle tracking echocardiography ( STE ) might give more insight into LA substrates and be therefore of predictive value . Methods This prospect i ve single-center pilot study included 31 patients ( mean age , 62.3 ± 9.1 years ; 19 males ) with AF who underwent PVI and 20 matched healthy controls ( mean age , 60.6 ± 6.6 years ; 10 males ) .  2D STE strain indices of LA reservoir ( RLA ) , conduit , and , if feasible , contractile function , were analyzed before and 6 months after PVI . Assessment of the LV diastolic function was based on st and ard indices . Responders to PVI were defined as being asymptomatic and free of AF in a 7-day Holter-ECG after 6 months . Results At baseline , all patients with AF had significantly lower reservoir and contractile function compared with controls . After 6 months , 17 patients ( 54.8 % ) were identified as responders . At baseline , the reservoir function was significantly higher in responders compared with nonresponders ( 32.7 ± 11.1 vs. 22.9 ± 10.9 % ; P = 0.019 ) . Only in responders , RLA and contractile LA function improved and reached normal values whereas LA function remained unchanged in nonresponders . In a ROC analysis , a RLA value of ≥19.5 % discriminated responders and nonresponders in patients with persistent AF with a sensitivity of 86 % and a specificity of 100 % ( P = 0.012 ; area under the curve 0.943 ; CI , 0.81–1.0 ) . Conclusions LA reservoir function helps to predict efficacy of PVI after 6 months . Only in responders , reservoir , and contractile function normalized within 6 months after PVI indicating a lower level of atrial remodeling at baseline . No deleterious effects of ablation were detected in nonresponders Background — Isolated atrial fibrillation ( AF ) is associated with mild enlargement of the left atrium ( LA ) and left ventricular ( LV ) diastolic dysfunction . The impact of ablation of isolated AF on left chamber size and function is unclear , and whether diastolic dysfunction is the cause or the consequence of AF remains unknown . The objective of this prospect i ve study was to evaluate the impact of sinus rhythm restoration by catheter ablation on LV diastolic dysfunction , LA morphology , and mechanical function . Methods and Results — Forty-eight patients with isolated AF were studied by serial echocardiographic studies at baseline and at 1- , 3- , 6- , 9- , and 12-month intervals after radiofrequency ablation .  LA dimensions and mechanical function and LV systolic and diastolic functions were evaluated at each time interval . Diastolic function was assessed with conventional Doppler parameters and new indexes such as tissue Doppler imaging , mitral flow propagation velocity , and combined criteria . LV diastolic dysfunction was present in paroxysmal and chronic AF patients with a reduction of tissue Doppler imaging lateral early diastolic peak velocity in 37 % ( P<0.001 ) and 48 % ( P<0.01 ) , respectively , compared with healthy control subjects . At the end of the follow-up , LA area decreased significantly by 18 % ( P<0.001 ) in paroxysmal and 23 % ( P<0.05 ) in chronic AF patients . Diastolic function improved significantly with an increase in lateral early diastolic peak velocity of 29 % ( P<0.001 ) in paroxysmal AF and 46 % ( P<0.05 ) in chronic AF patients . A significant increase in LV ejection fraction was also noted for both groups : 7.7 % and 18.8 % , respectively . Conclusions — This study demonstrates reverse morphological remodeling of the LA and improvement of LV diastolic and systolic functions after restoration of sinus rhythm by ablation for isolated AF . Because patients with isolated AF have none of the traditional causes of LV diastolic dysfunction , our findings suggest that AF may be partly the cause rather than the consequence of diastolic dysfunction Background —Early detection of structural changes in left atrium ( LA ) before atrial fibrillation ( AF ) development could be helpful in identification of those at higher risk for AF . Using cardiac magnetic resonance imaging , we examined the association of LA volume and function , and incident AF in a multiethnic population free of clinical cardiovascular diseases . Methods and Results —In a case – cohort study embedded in MESA ( Multi-Ethnic Study of Atherosclerosis ) , baseline LA size and function assessed by cardiac magnetic resonance feature-tracking were compared between 197 participants with incident AF and 322 participants r and omly selected from the whole MESA cohort . Participants were followed up for 8 years . Incident AF cases had a larger LA volume and decreased passive , active , and total LA emptying fractions and peak global LA longitudinal strain ( peak LA strain ) at baseline . In multivariable analysis , elevated LA maximum volume index ( hazard ratio , 1.38 per SD ; 95 % confidence interval , 1.01–1.89 ) and decreased peak LA strain ( hazard ratio , 0.68 per SD ; 95 % confidence interval , 0.48–0.96 ) , and passive and total LA emptying fractions ( hazard ratio for passive LA emptying fractions , 0.55 per SD ; 95 % confidence interval , 0.40–0.75 and hazard ratio for active LA emptying fractions , 0.70 per SD ; 95 % confidence interval , 0.52–0.95 ) , but not active LA emptying fraction , were associated with incident AF . Conclusions —Elevated LA volumes and decreased passive and total LA emptying fractions were independently associated with incident AF in an asymptomatic multiethnic population . Including LA functional variables along with other risk factors of AF may help to better risk stratify individuals at risk of AF development BACKGROUND Pre-procedural predictors ( PP ) of  atrial fibrillation ( AF ) recurrence ( AFR ) after repeated catheter ablation of AF ( RCAF )  are unknown . The aim of this study was identification of PP of outcome after RCAF . METHODS AND RESULTS In 213 patients ( 73 % male ) with drug-refractory AF ( 47 % paroxysmal AF ; PAF ) RCAF was performed . CHADS2 , CHA2DS2-VASc and ALARMEc ( AF type , Left Atrium size , Renal insufficiency , MEtabolic syndrome , cardiomyopathy ) scores were calculated for each patient . Complete success was defined as no AFR . After RCAF , 125 patients ( 59 % ) were free of atrial flutter or atrial tachycardia ( AFLAT ) on long-term follow-up ( FU ) . The univariate predictors of AFR were : type of AF ( non-PAF vs. PAF , P=0.001 ) , normalized left atrium area ( NLA ≥10.25 vs. NLA < 10.25 , P=0.012 ) and estimated glomerular filtration rate ( < 68ml/min vs. ≥68ml/min , P=0.048 ) . The independent predictors of AFLAT-free survival after RCAF were non-PAF ( P=0.002 ) and NLA ≥10.25 ( P=0.018 ) . Among combined predictors , only ALARMEc score , and neither CHADS2 or CHA2DS2-VASc , predicted outcome after RCAF ( P<0.0001 ) . CONCLUSIONS RCAF results in a moderate success rate on very long-term FU . Lower success was observed in patients with non-PAF and enlarged LA . ALARMEc score allows for clear description of expected outcome after RCAF BACKGROUND The aim of this prospect i ve study was to evaluate the recurrences of atrial fibrillation ( AF ) and flutter ( AFL ) after circumferential pulmonary vein ablation ( CPVA )  using repetitive long-term Holter recordings , and to evaluate the change in quality of life ( QoL ) , especially in patients with asymptomatic AF recurrences . METHODS A total of 149 patients with AF were followed up with 7-day Holter monitoring at 3 , 6 , and 12 months after CPVA .  We calculated the burden of AF/AFL defined as the percentage of time in AF/AFL , and patients with documented arrhythmia were divided into isolated symptomatic episodes of arrhythmia , mixed symptomatic/asymptomatic arrhythmia , or isolated asymptomatic arrhythmia . The QoL was analyzed with SF-36 question naires in patients with sinus rhythm after CPVA , and in patients with recurrence of symptomatic and asymptomatic arrhythmia , respectively . RESULTS Asymptomatic arrhythmia was observed in 44 % of the patients with documented arrhythmia at 12 months of follow-up . In patients with persistent AF , 63 % of the documented arrhythmia at 12 months of follow-up was asymptomatic and often persistent . In the subgroup of patients with asymptomatic arrhythmia , the QoL improved significantly in the physical scores , in contrast to patients with symptomatic arrhythmia who had unchanged or worsened QoL scores . CONCLUSIONS Asymptomatic arrhythmia is very common after AF ablation . Our data indicate that these patients improve their physical component of the QoL significantly , which may be considered a palliative success of treatment . We suggest that patients with asymptomatic AF recurrences are carefully evaluated before considering reablation . Repetitive rhythm monitoring after AF ablation is very important considering the postablation management of anticoagulant therapy OBJECTIVES We sought to compare left atrial ( LA ) volume to LA area and diameter for the prediction of adverse cardiovascular outcomes . BACKGROUND The incremental value of LA volume compared with LA area or diameter as a cardiovascular risk marker has not been evaluated prospect ively for patients with sinus rhythm or atrial fibrillation ( AF ) . METHODS Left atrial size was assessed with biplane LA volume , four-chamber LA area , and M-mode dimension for 423 patients ( mean age 71 + /- 8 years , 56 % men ) who were prospect ively followed for development of first AF , congestive heart failure , stroke , transient ischemic attack , myocardial infa rct ion , coronary revascularization , and cardiovascular death . RESULTS Of the 317 subjects in sinus rhythm at baseline , 62 had 90 new events during a mean follow-up of 3.5 + /- 2.3 years . All three LA size parameters were independently predictive of combined outcomes ( all p < 0.0001 ) . The overall performance for the prediction of cardiovascular events was greatest for LA volume ( area under the receiver operator characteristic curve : indexed LA volume 0.71 ; LA area 0.64 ; LA diameter 0.59 ) . A grade d association between the degree of LA enlargement and risk of cardiovascular events was only evident for indexed LA volume . For subjects with AF , there was no association between LA size and cardiovascular events . CONCLUSIONS Left atrial volume is a more robust marker of cardiovascular events than LA area or diameter in subjects with sinus rhythm . The predictive utility of LA size for cardiovascular events in AF was poor , irrespective of the method of LA size quantitation Aims The objective of the study was to analyse the influence of left ventricular ( LV ) ejection fraction ( EF ) on the outcomes of  atrial fibrillation ( AF ) ablation after a first procedure . Pre-procedural predictors of recurrences after AF ablation can be useful for patient information and selection of c and i date s. The independent influence of LV systolic dysfunction on recurrence rate has not been studied . Methods and results A case – control study ( 1:1 ) was conducted with a total of 72 patients : 36 cases ( depressed LVEF ) and 36 controls ( normal LVEF ) . Patients were matched by left atrial diameter ( LAD ) , the presence of arterial hypertension , and other variables that might influence the results ( age , gender and paroxysmal vs. persistent AF ) . There were no statistical differences in the variables used to perform the matching . Patients with depressed LVEF had higher LV end diastolic diameter ( 55.6 ± 6.2 vs. 52.4 ± 5.5 , P = 0.03 ) , higher LV end systolic diameter ( 40.3 ± 6.9 vs. 32.6 ± 4.3 , P < 0.001 ) , lower LVEF ( 41.4 ± 8.0 vs. 63.1 ± 5.5 , P < 0.001 ) and were more likely to have structural heart disease . After a mean follow-up of 16 ± 13 months , survival analysis for AF recurrences showed no differences between patients with depressed vs. normal LVEF ( 50.0 vs. 55.6 % , log rank = 0.82 ) . Cox regression analysis revealed LAD to be the only variable correlated to recurrence [ OR 1.11 ( 1.01–1.22 ) , P = 0.03 ] . Analysis at 6 months showed a significant increase in LVEF ( 43.23 ± 7.61 to 51.12 ± 13.53 % , P = 0.01 ) for the case group . Conclusion LV systolic dysfunction by itself is not a predictor of outcome after AF ablation . LAD independently correlates with outcome in patients with low or normal LVEF Background —There has been growing concern that linear ablation is associated with an increased risk of iatrogenic arrhythmias in patients undergoing ablation for atrial fibrillation ( AF ) . Therefore , we compared circumferential pulmonary vein ablation plus left atrial linear ablation ( CPVA+LALA ) with segmental pulmonary vein isolation (PVI)in  patients with paroxysmal AF . Methods and Results —Sixty-six consecutive patients with paroxysmal AF were prospect ively r and omly assigned to receive PVI versus CPVA+LALA ( consisting of encircling lesions around the pulmonary veins ) , a roof line , and a mitral isthmus line with documentation of bidirectional mitral isthmus block . All patients were seen at 1 , 3 , 6 , and every 12 months after ablation , with 14-day continuous ECG monitoring every 6 months . At 16.4±6.3 months after 1 ablation procedure , 19 patients ( 58 % ) remained free of atrial arrhythmias after PVI versus 17 patients ( 51 % ) after CPVA+LALA ( P=0.62 ) . After PVI , 14 patients had recurrent paroxysmal AF , whereas after CPVA+LALA , 8 patients had recurrent AF , 6 had atypical left atrial flutter ( LAFL ) , and 2 had both AF and LAFL ( P=0.32 between PVI versus CPVA+LALA for AF but P=0.002 for LAFL ) . Twenty-eight patients ( 85 % ) remained arrhythmia-free after 1.3±0.5 PVI procedures versus 28 patients ( 85 % ) after 1.4±0.6 CPVA+LALA procedures ( P = NS ) . Fluoroscopy time was longer after CPVA+LALA versus PVI ( 91 versus 73 minutes , P=0.04 ) . Conclusions —As an initial ablation approach in patients with paroxysmal AF  , more LAFL occurred after CPVA+LALA and fluoroscopy times were longer compared with segmental PVI The aim of this prospect i ve study was to evaluate the incremental value of left atrial ( LA ) function for the prediction of risk for first atrial fibrillation ( AF ) or atrial flutter . Maximum and minimum LA volumes were quantitated by echocardiography in 574 adults ( mean age 74 + /- 6 years , 52 % men ) without a history or evidence of atrial arrhythmia . During a mean follow-up period of 1.9 + /- 1.2 years , 30 subjects ( 5.2 % ) developed electrocardiographically confirmed AF or atrial flutter . Subjects with new AF or atrial flutter had lower LA reservoir function , as measured by total LA emptying fraction ( 38 % vs 49 % , p < 0.0001 ) and higher maximum LA volumes ( 47 vs 40 ml/m(2 ) , p = 0.005 ) . An increase in age-adjusted risk for AF or atrial flutter was evident when the cohort was stratified according to medians of LA emptying fraction ( < or = 49 % : hazard ratio 6.5 , p = 0.001 ) and LA volume ( > or = 38 ml/m(2 ) : hazard ratio 2.0 , p = 0.07 ) , with the risk being highest for subjects with concomitant LA emptying fractions < or = 49 % and LA volume > or = 38 ml/m(2 ) ( hazard ratio 9.3 , p = 0.003 ) . LA emptying fraction ( p = 0.002 ) was associated with risk for first AF or atrial flutter after adjusting for baseline clinical risk factors for AF or atrial flutter , left ventricular ejection fraction , diastolic function grade , and LA volume . In conclusion , reduced LA reservoir function markedly increases the propensity for first AF or atrial flutter , independent of LA volume , left ventricular function , and clinical risk factors BACKGROUND Complex fractionated electrograms ( CFEs ) are continuous electrograms ( EGMs ) of very short cycle length ( CL ) representing substrate for atrial fibrillation ( AF ) perpetuation . Ablation of CFEs may result in AF slowing , termination , and prevention , but identifying them can be subjective . OBJECTIVE The purpose of this study was to prospect ively assess ( 1 ) whether an automated algorithm can identify CFE regions , ( 2 ) the acute effects of ablating these regions on AF , and ( 3 ) the long-term efficacy as an adjuvant strategy to pulmonary vein antrum isolation ( PVAI ) . METHODS Thirty-five patients ( three centers , 61 + /- 9 years , left atrium [ LA ] 43 + /- 9 mm , ejection fraction 53 % + /- 7 % ) with symptomatic paroxysmal ( n = 21 ) or persistent ( n = 14 ) AF were studied . A decapolar lasso ( 2-mm spacing ) was used for mapping . A three-dimensional shell of the LA and pulmonary veins ( PVs ) was created . If not already in AF , AF was induced by burst pacing ( with or without isoproterenol ) . Atrial EGMs during AF were mapped/analyzed using an automated CFE algorithm . The algorithm measures the time between discrete deflections in a local EGM over 5 seconds ( based on selectable width and peak-to-peak [ > 0.03 mV ] criteria ) . The mean CL of the local EGM is projected onto the LA shell as a color-coded display . Regions of CL < 120 ms ( published criteria ) were targeted for ablation/elimination . Atrial fibrillation cycle length ( AFCL ) and regularity were measured from the CS . After CFE ablation , further ablation was done to achieve complete PVAI . RESULTS AF was spontaneous ( n = 20 ) or induced ( n = 15 ) in all patients . CFEs were most commonly found along the septum ( 97 % ) , anterior LA ( 97 % ) , PV antra ( 83 % ) , base of appendage ( 83 % ) , and annulus ( 71 % ) . CFE ablation alone prolonged the AFCL ( 171 + /- 27 vs. 304 + /- 41 ms ; P = .03 ) and regularized AF to left/right flutter ( AFL ) in 74 % of patients . CFE ablation terminated AF/AFL in 19 patients (54%)-the other 16 were cardioverted- and AF became noninducible in 77 % . CFE ablation alone did not cause PV isolation ( 0.1 + /- 0.3 PV isolated/patient ) . After combined CFE and PVAI ablation , the single-procedure , off-drug success rate was 83 % ( follow-up 13 + /- 4 months ) versus 71 % in matched controls who had PVAI alone ( P = .045 ) . CONCLUSIONS CFE ablation guided by an automated algorithm result ed in AFCL prolongation , regularization , and noninducibility in most patients . AF terminated in 54 % of cases . PVAI with adjuvant CFE ablation has a high efficacy and may be superior to PVAI alone AIMS The aim of this prospect i ve study was to evaluate left atrial ( LA ) function for the prediction of increased risk of new-onset non-valvular atrial fibrillation ( AF ) .  Risk stratification for new-onset AF based on LA remodelling may have a major public health impact . Although left atrial volume ( LAV ) or LA dimension have been proposed as predictors of AF , other predictive parameters of LA function have not yet been fully examined . METHODS AND RESULTS LA emptying function ( EF ) , strain rate ( SR ) , and LAV were evaluated in the apical four-chamber view by speckle tracking echocardiography in 580 consecutive adults ( age 64 ± 17 , 303 men ) without a history of atrial arrhythmias . During a follow-up period of 28 months , 32 subjects ( age 73 ± 9 , 18 men ) developed electrocardiographically confirmed AF . Subjects with new-onset AF had lower LA active EF ( 16 ± 5 vs. 28 ± 8 % , P < 0.001 ) and lower LA SR at atrial contraction ( -0.9 ± 0.2 vs. -1.4 ± 0.5 S(-1 ) , P < 0.001 ) , but larger maximum LAV index ( 59 ± 12 vs. 46 ± 16 mL/m(2 ) , P < 0.001 ) compared with non-AF subjects at baseline . In multivariate logistic regression analysis , LA active EF was the only independent predictor of new-onset AF . Using an LA active EF cut-off of ≤20 % , the sensitivity and specificity for new-onset AF based on receiver operator characteristic curve analysis were 88 and 81 % , respectively ( area under the curve : 0.92 ) . CONCLUSION Reduced LA active EF ( booster pump function ) assessed by speckle tracking echocardiography independently predicts the risk of new-onset AF , suggesting a stronger association between LA functional remodelling and AF than between LA size and AF Background —Atrial flutter ( AFL ) and atrial fibrillation ( AF ) frequently coexist in the same patient . Recently it has been demonstrated that the triggers for both AF and AFL may originate in the pulmonary veins ( PVs ) . We hypothesized that in patients with both AF and typical AFL , pulmonary vein – left atrial junction ( PV-LAJ ) disconnection may eliminate both arrhythmias . Methods and Results —Consecutive patients with documented symptomatic AF and typical AFL were r and omly assigned to have PV-LAJ disconnection combined with cavotricuspid isthmus ( CTI ) ablation ( group 1 , n=49 ) or PV-LAJ disconnection alone ( group 2 , n=59 ) . Within the first 8 weeks after ablation , 32 of the group 2 patients had typical AFL documented , whereas none was seen in group 1 . Twenty of these 32 converted to sinus rhythm after initiating antiarrhythmic drugs ( AADs ) . Twelve were cardioverted , and AADs were started . After 8 weeks , all AADS were stopped , and only 3 patients continued to have recurrent sustained typical AFL that was eliminated by CTI ablation . Beyond 8 weeks of follow-up , 7 patients in group 1 and 6 patients in group 2 ( 14 % and 11 % , respectively ) continued to have AF . Ten of these 13 patients underwent a repeat PV-LAJ disconnection procedure and were cured . The remaining 3 remained in normal sinus rhythm while taking AADs . Conclusions —In patients with both AFL and AF , PV-LAJ disconnection alone may be sufficient to control both arrhythmias . CTI block reduced early postablation recurrence of arrhythmias , which in the majority of patients reflects a short-term clinical problem BACKGROUND Atrial fibrillation ( AF ) is a common complication of coronary artery bypass grafting ( CABG ) . However , limited information is available about the role of preoperative echocardiographic left atrial evaluation to predict AF occurrence after CABG . Thus , we prospect ively compared the ability of echocardiographic measurements of left atrial volume to predict AF in this setting . METHODS From January to December 2009 , 220 patients ( 75 % males , 66.8 ± 10.0 years ) met the inclusion criteria of our study ( isolated and elective CABG , no valve surgery , no permanent AF , or other chronic atrial arrhythmias ) . The day before CABG a complete echocardiographic evaluation was performed with left atrial volume measurements . The primary endpoint of the study was postoperative AF ( POAF ) lasting > 30 seconds . RESULTS POAF was observed in 61 patients ( 27.7 % ) . POAF patients showed increased left atrial M-mode anteroposterior dimension ( 41.2 ± 6.4 mm vs. 43.6 ± 7.3 mm ; p = 0.020 ) and increased left atrial volume ( 59.0 ± 18.3 mL vs. 70.6 ± 28.1 mL ; p = 0.0004 ) . Left atrial volume was an independent risk factor for POAF ( OR 10.03 ; 95 % CI 10.01 to 10.05 ; p = 0.01 ) , along with postoperative bleeding with hemoglobin levels below 8 g/dL ( OR 20.84 ; 95 % CI 10.12 to 70.19 ; p = 0.03 ) and preoperative left ventricular ejection fraction below 40 % ( OR 10.08 ; 95 % CI 10.01 to 10.15 ; p = 0.02 ) . Conversely , preoperative statin therapy exerted a protective role ( OR 0.30 ; 95 % CI 0.12 to 0.74 ; p = 0.009 ) . CONCLUSION Preoperative echocardiographic evaluation of patients with isolated CABG demonstrated that left atrium volume measurements were independently correlated to the occurrence of POAF . Further investigations should focus on the opportunity to target prophylactic antiarrhythmic treatments to patients with large left atrial volumes Background —Pulmonary veins ( PVs ) play a pivotal role in initiating and perpetuating  atrial fibrillation ( AF ) . We investigated if PV electrical isolation from the left atrium is required for curing AF . Methods and Result —Fifty-one patients with paroxysmal or persistent AF underwent circumferential radiofrequency ablation of PV ostia performed with an anatomic approach . The end point of the ablation procedure was the recording of low peak-to-peak bipolar potentials ( < 0.1 mV ) inside the lesions . Left atrium pacing was used to assess the conduction between the PVs and the left atrium . During a mean follow-up period of 16.6±3.9 months , 41 patients ( 80.4 % ) were free of atrial arrhythmias . When patients with and without AF recurrence were analyzed , no significant difference was observed in the mean number of PVs in which the ablation end point was reached ( 3.4±1.2 versus 3.7±0.87 ) and PVs isolated ( 1.5±1.4 versus 1.6±1 ) . We noted that , although in 29 of 41 patients ( 71 % ) without AF recurrence , the ablation end point was reached in all PVs mapped , it was only possible to demonstrate the isolation of all PVs mapped in 2 patients . On the other h and , in 7 of 10 patients ( 70 % ) with AF recurrence , the ablation end point was reached in all PVs mapped , whereas one patient had all PVs isolated . Conclusions —Our findings show that with the use of a pure anatomic approach , it is possible to prevent AF in > 80 % of patients undergoing catheter ablation . Moreover , the isolation of PVs is not crucial for curing AF
Dilated LA significantly increases the risk of AF recurrence after  single CPVI .
This is especially applicable to the patients with long-term follow-up
AIMS Left atrial ( LA ) enlargement is associated with atrial fibrillation ( AF ) .
However , it is controversial whether dilated atrium can predict post-ablation AF recurrence .
We undertook a systematic review and meta- analysis to analyse the association between LA diameter and  AF recurrence after single circumferential pulmonary vein isolation ( CPVI )  and explore the potential mechanism .