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Impact of the size of non-ablated left atrial posterior wall area on outcomes after extensive encircling pulmonary vein isolation

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Abstract

The aim of this study was to evaluate the impact of the size of the isolated surface area and non-ablated left atrial posterior area after extensive encircling pulmonary vein isolation (EEPVI) for non-paroxysmal atrial fibrillation (AF) on arrhythmia recurrence. This study included 132 consecutive persistent AF patients who underwent EEPVI guided by Ablation Index (AI). The isolated antral surface area (IASA) excluding the pulmonary veins, the non-ablated left atrial (LA) posterior wall surface area (PWSA), the ratio of IASA to LA surface area (IASA/LA ratio), and the ratio of PWSA to LA surface area (PWSA/LA ratio) were assessed using CARTO3 and the association with AF and atrial tachycardia (AT) recurrence was examined. At a mean follow-up of 13.2 ± 7.3 months, sinus rhythm was maintained in 115 (87%) patients. In the univariate Cox regression analysis, the factors that significantly predicted AT/AF recurrence were a history of heart failure, a higher CHA2DS2-VASc score, a larger LA diameter, and a larger PWSA/LA ratio. Multivariate Cox regression analysis revealed that the independent predictors of AT/AF recurrence were LA diameter [hazard ratio (HR) 1.120 per 1 mm increase; 95% confidence interval (CI) 1.006–1.247; P = 0.039] and PWSA/LA ratio (HR 1.218 per 1% increase; 95% CI 1.041–1.425; P = 0.014). Receiver operating characteristics curve analysis yielded an optimal cut-off value of 8% for the PWSA/LA ratio. The Kaplan–Meier survival curve showed that patients with a larger PWSA/LA ratio had poorer clinical outcomes (Log-rank P = 0.001). A larger PWSA/LA ratio was associated with a high AT/AF recurrence rate in patients with non-paroxysmal atrial fibrillation.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Funding

This study received no funding.

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Authors and Affiliations

  1. Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan

    Shingo Yoshimura, Kenichi Kaseno, Kohki Kimura, Wataru Sasaki, Yoshinori Okazaki, Yumiko Haraguchi, Shohei Kishi, Takehito Sasaki, Koji Goto, Yuko Miki, Yutaka Take, Kohki Nakamura & Shigeto Naito

Authors
  1. Shingo Yoshimura
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  2. Kenichi Kaseno
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  3. Kohki Kimura
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  4. Wataru Sasaki
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  5. Yoshinori Okazaki
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  6. Yumiko Haraguchi
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  7. Shohei Kishi
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  8. Takehito Sasaki
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  9. Koji Goto
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  10. Yuko Miki
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  11. Yutaka Take
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  12. Kohki Nakamura
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  13. Shigeto Naito
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Contributions

All authors contributed to the study conception and design.

Corresponding author

Correspondence to Shingo Yoshimura.

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The authors declare that they have no conflict of interest.

Ethics approval

Ethical approval was waived by the local Ethics Committee of Gunma Prefectural Cardiovascular Center in view of the retrospective nature of the study and given that all the procedures being performed were part of routine care.

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Yoshimura, S., Kaseno, K., Kimura, K. et al. Impact of the size of non-ablated left atrial posterior wall area on outcomes after extensive encircling pulmonary vein isolation. Heart Vessels 36, 1421–1429 (2021). https://doi.org/10.1007/s00380-021-01820-3

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  • DOI: https://doi.org/10.1007/s00380-021-01820-3

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