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Association of left atrial wall thickness with recurrence after cryoballoon ablation of paroxysmal atrial fibrillation

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Abstract

Background

Transmural injury plays a role in successful atrial fibrillation ablation. The effect of left atrial wall thickness (LAWT) on the efficacy of radiofrequency ablation has been identified, but data on the relationship between LAWT and cryoballoon for paroxysmal atrial fibrillation (PAF) are lacking. We aim to explore the relationship between LAWT and recurrence after cryoballoon ablation (CBA).

Methods

We studied 364 patients (mean age 62 years) with PAF who underwent a second-generation CBA and pre-procedure cardiac CTA. LAWT and left atrial volume index (LAVI) were obtained based on pre-procedure cardiac CTA measurements. Follow-up was at least 12 months and predictors of atrial tachyarrhythmia recurrence during follow-up were assessed.

Results

Patients were followed up for a median of 19 (12–28) months, with an atrial tachyarrhythmia-free rate of 77.5% after cryoablation. Greater LAVI (50.0 ± 19.6 mL/m2 vs. 44.3 ± 15.4 mL/m2, P = 0.018) and greater LAWT (1.67 ± 0.24 vs. 1.46 ± 0.25 mm, P < 0.001) were associated with atrial tachyarrhythmia recurrence. The mean LAWT of PV antrum correlated with TTI (R = 0.252, P < 0.001). Adding LAWT to the established risk model improved both the discrimination and reclassification effects (IDI: 0.099, 95% CI: 0.065–0.134, P < 0.001; NRI: 0.685, 95% CI: 0.455–0.915, P < 0.001). In a multivariable Cox proportional hazard model, the mean LAWT of PV antrum (hazard ratio [HR]:3.657, 95%CI: 2.319–5.765, P < 0.001) was an independent predictor of atrial tachyarrhythmia recurrence after cryoablation.

Conclusions

The mean LAWT of PV antrum, obtained from preoperative measurements on CT, was associated with atrial tachyarrhythmia recurrence after cryoablation.

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Acknowledgements

The authors gratefully acknowledge the financial support from the Regional Innovation Cooperation Program of Science and Technology Department of Sichuan Province (2022YFQ0009) and the Key Research and Development Project of Science and Technology Department of Sichuan Province (2021YFS0083).

Funding

The authors gratefully acknowledge the financial support from the Regional Innovation Cooperation Program of Science and Technology Department of Sichuan Province (2022YFQ0009) and the Key Research and Development Project of Science and Technology Department of Sichuan Province (2021YFS0083).

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Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Yixuan Bai, Ruikun Jia, Xinmeng Wang, Juan Chan & Kaijun Cui

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  1. Yixuan Bai
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  2. Ruikun Jia
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  3. Xinmeng Wang
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Correspondence to Kaijun Cui.

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Ethical approval and consent to participate

All patients signed an informed consent form, and the registry was approved by the Research Ethics Committee of the West China Hospital, following the Declaration of Helsinki.

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The authors declare that they have no competing interests.

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Yixuan Bai and Ruikun Jia Contributed equally.

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Bai, Y., Jia, R., Wang, X. et al. Association of left atrial wall thickness with recurrence after cryoballoon ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 67, 657–667 (2024). https://doi.org/10.1007/s10840-023-01691-w

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  • DOI: https://doi.org/10.1007/s10840-023-01691-w

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