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Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation
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  • Judit Simon,
  • Mohammed El Mahdiui,
  • Jeff Smit,
  • Lili Száraz,
  • Alexander van Rosendael,
  • Szilvia Herczeg,
  • Emese Zsarnóczay,
  • Anikó Nagy,
  • Márton Kolossváry,
  • Bálint Szilveszter,
  • Nandor Szegedi,
  • Klaudia Vivien Nagy,
  • Tamás Tahin,
  • Laszlo Geller,
  • Rob van der Geest,
  • Jeroen Bax,
  • Pál Maurovich-Horvat,
  • Bela Merkely
Judit Simon
Semmelweis University
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Mohammed El Mahdiui
Leiden University Medical Center
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Jeff Smit
Leiden University Medical Center
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Lili Száraz
Heart and Vascular Centre of Semmelweis University
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Alexander van Rosendael
Leiden University Medical Center
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Szilvia Herczeg
Heart and Vascular Center of Semmelweis University
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Emese Zsarnóczay
Semmelweis University
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Anikó Nagy
Semmelweis University
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Márton Kolossváry
Heart and Vascular Centre of Semmelweis University
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Bálint Szilveszter
Heart and Vascular Centre of Semmelweis University
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Nandor Szegedi
Heart and Vascular Centre of Semmelweis University
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Klaudia Vivien Nagy
Semmelweis University
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Tamás Tahin
Semmelweis Egyetem
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Laszlo Geller
Semmelweis University
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Rob van der Geest
LUMC
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Jeroen Bax
Leiden University Medical Center
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Pál Maurovich-Horvat
Heart and Vascular Centre of Semmelweis University
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Bela Merkely
Semmelweis University
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Abstract

Introduction Catheter ablation is an established therapy for rhythm control in patients with drug-refractory atrial fibrillation (AF), however, recurrence is frequent particularly in persistent AF. There are no consistently confirmed predictors of AF recurrence after catheter ablation. Therefore, we aimed to study whether LAA volume (LAAV) and function influence the long-term recurrence of AF after catheter ablation, depending on AF type. Methods AF patients who underwent point-by-point radiofrequency catheter ablation after cardiac computed tomography (CT) were included in this analysis. LAAV and LAA orifice area were measured by CT. Uni- and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence. Results In total, 561 AF patients (61.910.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence-free time of 22.7 9.3-43.1 months. Patients with persistent AF had significantly higher iLAV, LAAV, LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment left ventricular ejection fraction (LVEF) <50% (HR=2.17; 95%CI=1.38-3.43; p<0.001) and LAAV (HR=1.06; 95%CI=1.01-1.12; p=0.029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF. Conclusion The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF.