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A Thin Left Atrial Antral Wall Around the Pulmonary Vein Reflects Structural Remodeling by Atrial Fibrillation and is Associated with Stroke

 Junbeom Park  ;  Chul Hwan Park  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
 YONSEI MEDICAL JOURNAL, Vol.58(2) : 282-289, 2017 
Journal Title
Issue Date
Aged ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology* ; Atrial Fibrillation/surgery* ; Catheter Ablation/adverse effects ; Catheter Ablation/methods* ; Female ; Heart Atria/physiopathology ; Humans ; Male ; Middle Aged ; Pulmonary Veins/physiopathology* ; Pulmonary Veins/surgery* ; Recurrence ; Reproducibility of Results ; Sensitivity and Specificity ; Stroke/physiopathology* ; Treatment Outcome
Pulmonary vein ; ablation ; reconnection ; stroke ; wall thickness
PURPOSE: Circumferential pulmonary (PV) vein isolation (CPVI) is the most important treatment strategy for atrial fibrillation (AF). While understanding left atrial wall thickness around PVs (PVWT) prior to catheter ablation is important, its clinical implications are not known. This study aimed to evaluate PVWT characteristics according to underlying disease and to identify associations between PVWT and reconnections of PV potentials (PVPs) in redo ablation.

MATERIALS AND METHODS: In 28 patients who underwent redo-AF ablation, PVWT and reconnected PVPs were evaluated at 12 sites (1-12 o'clock) around each PV. Clinical characteristics including stroke and CHA₂DS₂-VASc scores were analyzed according to the PVWT.

RESULTS: The PVWT was thicker in males than females (p<0.001) and in those with diabetes (p=0.045) or heart failure (p=0.002) than in those without. Patients with strokes or high CHA₂DS₂-VASc scores (≥3) had significantly thinner PVWTs than those without strokes or low CHA₂DS₂-VASc scores (p<0.001). In redo-ablation, reconnected PVPs were detected in 60 (53.6%) of 112 PVs, and the PVs were thicker (p<0.001) and had more reconnected PVs (p=0.009) than right PVs. A PVWT of >0.6 mm predicted PV reconnections with a sensitivity of 76.7% and specificity of 52.2% with an area under the curve of 0.695.

CONCLUSION: Thick PVWs were associated with diabetes and heart failure, and also showed significant inverse correlations with stroke and the CHA₂DS₂-VASc score. Thick PVWs were associated with reconnected PVPs after the CPVI, which were related to AF recurrence.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Beom(박준범)
Park, Chul Hwan(박철환) ORCID logo https://orcid.org/0000-0002-0004-9475
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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