scholarly journals Sex differences in the predictors of recurrent atrial fibrillation after catheter ablation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Tanaka ◽  
K Inoue ◽  
A Kobori ◽  
K Kazutai ◽  
T Morimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Large Scale ◽  
Funding Source ◽  
Recurrent Atrial Fibrillation ◽  
History Of ◽  
The Impact ◽  
Af Recurrence

Abstract Background The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We previously reported that females experienced more frequent AF recurrences than males after the index and last RFCA procedures. Purpose To identify the risk factors associated with recurrent AF in females and males after RFCA of AF. Methods We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Results The incidence of AF recurrences after a single procedure was 43.3% in females and 39.0% in males. After a multivariate adjustment at baseline, the significant predictors of AF recurrence in females after the index RFCA were non-paroxysmal AF (hazard ration [HR],1.59; 95% confidence interval [CI],1.31–1.93, p<0.0001), a history of AF ≥2 years (HR,1.47; 95% CI,1.24–1.74, p<0.0001), coronary artery disease (HR,1.43; 95% CI,1.03–1.98, p=0.0035), and an estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 (HR,1.46; 95% CI,1.10–1.95, p=0.0086). On the other hand, significant predictors of AF recurrence in males after the index RFCA were non-paroxysmal AF (HR,1.54; 95% CI,1.37–1.73, p<0.0001), a history of AF ≥2 years (HR,1.40; 95% CI,1.26–1.56, p<0.0001), the number of antiarrhythmic drugs (HR,1.06; 95% CI,1.003–1.13, p=0.040), a left atrial diameter≥40mm (HR,1.13; 95% CI,1.007–1.27, p=0.038), and dilated cardiomyopathy (HR,1.55; 95% CI,1.07–2.26, p=0.021), however, an eGFR<60 mL/min/1.73m2 was not associated with AF recurrence in males (HR, 1.00; 95% CI, 0.88–1.13, p=0.97). Conclusion The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the predictors of recurrent AF after RFCA. Non-Paroxysmal AF and a long history of AF were common risk factors both in females and males. However, renal dysfunction was a significant predictor of AF recurrence in females, while it was not a risk of recurrence in males. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.

Abstract 17296: Arrhythmia Recurrence and Subsequent Heart Failure Hospitalization in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Landmark Analysis From the Kansai Plus Atrial Fibrillation (KPAF) Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobuaki Tanaka ◽  
KOICHI INOUE ◽  
Atsushi Kobori ◽  
Kazuaki Kaitani ◽  
Takeshi Morimoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Large Scale ◽  
Multicenter Observational Study ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Af Recurrence

Background: Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) of AF is effective for maintaining sinus rhythm though its impact on heart failure still remains controversial. Purpose: We sought to elucidate whether AF recurrence following RFCA was associated with subsequent HF hospitalizations. Methods: We conducted a large-scale, prospective, multicenter, observational study. A total of 4931 consecutive patients who underwent an initial RFCA for AF with longer than 1-year of follow-up in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. The primary endpoint was an HF hospitalization more than 1-year after the index RFCA. We compared the patients without AF recurrences (group A) to those with AF recurrences within 1-year post RFCA (group B). Results: The 1-year cumulative incidence of AF recurrences after a single procedure was 30.7% (group A=3418, group B=1513 patients). Group B had a lower body mass index (group A vs. group B,24.1±3.6 vs. 23.8±3.4 kg/m 2 , p=0.014), longer history of AF (1.9 vs. 3.1 years, p<0.0001), higher prevalence of non-paroxysmal AF (32.1% vs. 33.9%, p<0.0001), and valvular heart disease (5.9% vs. 7.8%, p=0.013). They also had a lower ejection fraction (63.7±9.4% vs. 62.8±9.6%, p=0.0043) and larger left atrial dimeter (39.7±6.6 vs. 40.6±7.0 mm, p<0.0001) on echocardiography. Hospitalizations for HF were observed in 57 patients (1.14%) more than 1-year after the RFCA and were significantly higher in group B than group A (group A vs. group B, 0.91% vs 1.72%, log-rank p=0.019). Conclusions: Among AF patients receiving RFCA, those with AF recurrences were at a greater risk of subsequent heart failure hospitalizations than those without AF recurrences. Recognition that AF recurrence following RFCA is a risk factor for a subsequent HF-related hospitalization is appropriate in clinical practice.

scholarly journals Impact of Left Atrial Geometric Remodeling on Late Atrial Fibrillation Recurrence After Catheter Ablation

2021 ◽  
Author(s):  
Fuqian Guo ◽  
Caiying Li ◽  
Lan Yang ◽  
Chen Chen ◽  
Yicheng Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Volume Index ◽  
Multivariable Logistic Regression Analysis ◽  
Significant Difference ◽  
The Impact ◽  
Af Recurrence

Abstract Purpose: To quantitatively investigate the impact of left atrial (LA) geometric remodeling on atrial fibrillation (AF) recurrence after catheter ablation (CA).Methods: A retrospective analysis of 105 patients with AF who underwent coronary computed tomographic angiography before CA. Risk factors for AF recurrence were identified by multivariable logistic regression analysis and used to create a nomogram.Results: After at least 12 months of follow-up, 30 patients (29%) developed recurrent AF. Patients with recurrence had a higher LA volume, LA sphericity, and a lower LA ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that LA minimal volume index (LAVImin) (OR: 1.280, 95% CI: 1.027–1.594, P = 0.028), LA sphericity (OR: 1.268, 95% CI: 1.071–1.500, P = 0.006) and CHA2DS2-VASc score (OR: 1.326, 95% CI: 1.016–1.732, P=0.038) were independent predictors of AF recurrence. The combined model of the LA sphericity to the LAVImin substantially increased the predictive power for AF recurrence (area under the curve [AUC] = 0.736, 95% CI: 0.627–0.844, P < 0.001), with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.769 (95% CI: 0.666–0.872) and had good internal validity.Conclusion: The CHA2DS2-VASc score, LA sphericity, and LAVImin were significant and independent predictors of AF recurrence after CA. Furthermore, the nomogram had a better predictive capacity for AF recurrence.

Gender-dependent regulation of FABP4 and leptin according to atrial fibrillation burden

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.N Lopez-Canoa ◽  
M Couselo-Seijas ◽  
A Baluja ◽  
L Gonzalez-Melchor ◽  
A Rozados ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Previous History ◽  
Correlation Coefficients ◽  
Suspected Coronary Artery Disease ◽  
Public Institution ◽  
Funding Source ◽  
Af Recurrence

Abstract Aims Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Its associated proteins are differentially released between male and female. FABP4 and leptin are mediators in adipose tissue-inflammatory effects. Our aim was to study their gender differential behavior on mechanisms associated with AF progression. Methods and results Two independent cohorts were analyzed: A) patients referred for AF catheter ablation (n=217) and patients with suspected coronary artery disease referred for a CT scan (without previous history of AF) (n=105). Protein levels were determined by multiplex fluorometric immunoassay. Gene mRNA expression was analyzed by real time polymerase chain reaction. Correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients. Logistic regression and random forest model determined the best predictors of AF recurrence after catheter ablation. Our results showed: 1) a distinctive profile according to gender, with an increment of FABP4 levels in women (20±14, 29±18 and 31±17 ng/mL; p=0.007) and a decrease of leptin levels in men (22±15, 13±16 and 13±11 ng/mL; p=0.001) among control, paroxysmal and persistent AF groups, respectively; 2) sex differences regarding inflammatory profile, oxidative stress and autonomic indirect markers in AF; 3) a prominent role of adipokines to discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor (LR coefficient 1.067, 95% CI 1–1.14, p=0.046). Conclusion The major finding of the present study is the sex differences of FABP4 and leptin according to AF burden. The relationship of these adipokines with oxidative stress, inflammatory and autonomic indirect markers might explain part of the mechanisms underlying the AF perpetuation. Adipokines regarding Gender & AF burden Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Institute of Health Carlos III

P1395The role of hyponatremia in the development of atrial fibrillation after cardiac surgery

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Pavlikova ◽  
A Shevelyok ◽  
N Vatutin
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Serum Sodium ◽  
Sodium Level ◽  
Cox Regression ◽  
Serum Sodium Level ◽  
History Of ◽  
The Impact

Abstract Background. Atrial fibrillation (AF) is one of the most common complication after cardiac surgeries. Age, valvular heart disease, heart failure, chronic obstructive pulmonary disease and a history of AF are well known risk factors for postoperative AF. On the other hand, hyponatremia is also a frequent disorder in patients undergoing cardiac surgery but its relationship with AF has not been studied. Purpose. We evaluated the impact of hyponatremia on the incidence of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods. The retrospective study included case history of 222 patients (174 men and 48 women, median age 64.5 [range 58.0; 69.0] years) who underwent cardiac surgery with cardiopulmonary bypass between January 2015 and December 2018.  In all patients intraoperative sodium level was analyzed. Hyponatremia was defined as serum sodium level &lt; 135 mmol/l. Primary outcome was the episode of AF in postoperative period. Results. The incidence of postoperative AF was 18.9% (95% confidence interval (CI) 14.1-24.3 P = 0.05). Patients with AF more often had obesity, diabetes mellitus and a history of myocardial infarction and were more likely to perform combined surgery compared to non-AF patients (all Ps &lt; 0.05). The prevalence of hyponatremia was significantly higher among AF group compared with non-AF (95.2% versus 77.8%, P = 0.017). Hyponatremia was the independent risk factors of postoperative AF in Cox regression models adjusted for covariates (odds ratio 5.31; 95% CI 1.42-18.7; P = 0.017). Conclusion.  In this analysis serum sodium level was closely associated with the risk of AF. These findings suggest that hyponatremia may cause the development of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass.

Abstract 2161: Left Atrium Reverse Remodeling After Pulmonary Vein Isolation. Will It Be a Predictor for Non-recurrence of Atrial Fibrillation?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
kiyotake Ishikawa ◽  
Yukihiko Yoshida ◽  
Sumio Morita ◽  
Kenji Furusawa ◽  
Noriyoshi Kanemura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Reverse Remodeling ◽  
Transverse Diameter ◽  
Before And After ◽  
History Of ◽  
Af Recurrence

Background: Left atrium (LA) dilation plays an important role in development and persistence of atrial fibrillation (AF). Some cases show structural reverse remodeling of LA after catheter ablation of AF. The aim of this study was to assess the clinical significance of LA reverse remodeling. Method and Results: Echocardiographic data before and after ablation was obtained in 173 cases who underwent pulmonary vein isolation from January 2006 to April 2008 (74.0% men, 61.0±11 years old; paroxysmal AF 114, persistent AF 34, permanent AF 25). Mean atrial diameter before ablation was 39.0±6.1mm (paroxysmal 37.7±5.6mm, persistent 40.7±5.3mm, and permanent 43.0±6.8mm) and LA reverse remodeling was defined as 10% decrement of LA transverse diameter. Half of the cases were taking anti-arrhythmic drugs after ablation, and AF recurrence occurred in 16.8% (29/173) during mean follow up period of 8.5±6.3 months. Reverse remodeling of LA was seen in 34.1% (59/173) and AF recurrence rate in this group was 11.9% (7/59), whereas 19.3% (22/114) without reverse remodeling (P=0.29). However, limited in patients with LA diameter over 40mm (44.5%; 77/173), 3.2% (1/31) of AF recurrence was seen in those with reverse remodeling, while 21.7% (10/46) without reverse remodeling (P=0.04). LA reverse remodeling was observed significantly frequent in patients without history of hypertension(41.5% without hypertension vs 25.6% with hypertension, P=0.036). Conclusion: LA reverse remodeling after catheter ablation of AF in dilated LA patient is a simple and useful predictor for non-recurrence of AF. Hypertension could be a disturbance for LA reverse remodeling.

P980Post-procedural plasma brain natriuretic peptide level early after catheter ablation predicts the future clinical outcome in patients with persistent atrial fibrillation and reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Okada ◽  
K Tanaka ◽  
Y Ninomiya ◽  
Y Hirao ◽  
T Oka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcome ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Persistent Atrial Fibrillation ◽  
Cardiovascular Death ◽  
The Impact ◽  
Af Recurrence

Abstract Background Successful restoration of sinus rhythm (SR) by catheter ablation (CA) for persistent atrial fibrillation (AF) improves cardiac function, resulting in decrease of plasma brain natriuretic peptide (BNP) level. The exact significance and prognostic implications of this change have yet to be determined. Purpose To examine the impact of pre- and post-procedural BNP level on the clinical outcome after CA in patients with persistent AF and reduced left ventricular ejection fraction (LVEF). Methods Out of 242 patients with LVEF <50% who underwent first-time CA for persistent AF between March 2012 and September 2018 at our institute, we enrolled 137 patients (61±10 years, 83% male) whose plasma BNP level was available both at baseline and early after CA (during 1–3 month). We evaluated the impact of the BNP levels on future AF recurrence 3 months after CA as the primary endpoint. Additional secondary endpoints included heart failure (HF) hospitalization and cardiovascular death. Results All patients successfully restored SR at the end of CA. Within 3 months of a blanking period (BP), improvement of LVEF (from 39±10% to 65±12%, p<0.001) and reduction of BNP levels (from 178 [107–332] pg/ml to 42.3 [21.1–78.6] pg/ml, p<0.001) were observed. During the median follow-up of 21 months after BP, the incidence of AF recurrence, HF hospitalization, and cardiovascular death was 37% (n=50), 3% (n=4), and 1% (n=1), respectively. Cox proportional hazard regression analysis after adjustment for age and gender revealed that post-procedural BNP level was a significant predictor of the AF recurrence (hazard ratio [HR] per 100-pg/ml increase, 1.13; 95% confidence interval [CI], 1.02–1.25; p=0.023), but pre-procedural BNP level was not (1.02; 0.95–1.09; p=0.56). Receiver operating curve analysis determined the post-procedural BNP level of 55.5 pg/ml as the best cut-off value for predicting the AF recurrence, with area under the curve of 0.620 (95% CI, 0.534–0.702; p=0.018). The incidence of AF recurrence was significantly higher in patients with post-procedural BNP level >55.5 pg/ml (n=50) than the others (50% vs. 29%; HR, 3.99; 95% CI, 2.07–7.68; p<0.001). No patients with post-procedural BNP level ≤55.5 pg/ml experienced HF hospitalization and cardiovascular death (8% vs. 0% and 2% vs. 0%, p=0.006 and p=0.17, respectively) Conclusions Not pre-procedural but post-procedural BNP level early after CA predicted the future clinical outcome in patients with persistent AF and reduced LVEF. Decreased but still elevated BNP level after restoration of SR would identify the residual risk for developing unfavorable outcome.

Sex differences in atrial fibrillation ablation outcomes: insights from a large-scale multicentre registry

EP Europace ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. 1345-1357 ◽  
Author(s):  
Nobuaki Tanaka ◽  
Koichi Inoue ◽  
Atsushi Kobori ◽  
Kazuaki Kaitani ◽  
Takeshi Morimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Sex Differences ◽  
Clinical Outcomes ◽  
Large Scale ◽  
De Novo ◽  
Long Term Follow Up ◽  
Af Recurrence

Abstract Aim The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We investigated the sex differences regarding the efficacy and clinical outcomes of RFCA of AF. Methods and results We conducted a large-scale, prospective, multicentre, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centres (64 ± 10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Female patients (n = 1369, 27.3%) were older (female vs. male, 68 ± 9 vs. 63 ± 11 years, P &lt; 0.0001) with a lower prevalence of non-paroxysmal AF (27.1% vs. 38.9%, P &lt; 0.0001). Fewer females experienced time-dependent pulmonary vein (PV) reconnections and more females received a non-PV foci ablation than males in the index RFCA. The 3-year cumulative incidence of AF recurrences in the multivariate analysis after single procedures was significantly higher in females than males (43.3% vs. 39.0%, log rank P = 0.0046). Females remained an independent predictor of AF recurrence (hazard ratio 1.24; 95% confidence interval 1.12–1.38, P &lt; 0.0001). The AF recurrence rates after multiple procedures were also higher in females, but fewer females experienced PV reconnections during second sessions. More females experienced de novo pacemaker implantations during the long-term follow-up. Females were associated with a higher risk of heart failure hospitalizations and major bleeding after RFCA in the multivariate analysis. Conclusions Females experienced more frequent AF recurrences probably due to non-PV arrhythmogenicity and de novo pacemaker implantations than males during the long-term follow-up after RFCA of AF.

Efficacy and safety of catheter ablation for atrial fibrillation in patients with cancer

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ganatra ◽  
S Abraham ◽  
R Parikh ◽  
D Kamenetsky ◽  
R Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein Stenosis ◽  
Funding Source ◽  
Access Site ◽  
Patients With Cancer ◽  
Cancer Management ◽  
Thoracic Radiation ◽  
History Of ◽  
History Of Cancer

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer. Management of AF in patients with cancer poses unique challenges. Long-term use of antiarrhythmic drug (AAD) therapy lacks evidence of efficacy in this population and poses risk of drug interactions. Catheter ablation is a well-established treatment modality for AAD resistant symptomatic AF and in patients with heart failure. Nevertheless, the effectiveness and safety of catheter ablation in patients with cancer is not well established. Method We retrospectively analyzed consecutive patients who underwent catheter ablation for AF, with either history of cancer (other than non-melanoma skin cancer) within 5-years prior or exposure to systemic anthracycline and/or thoracic radiation therapy at any time. Results The study included 162 patients. The mean age was 65.5 (26–84 years) years and 50% were female. Overall 133 (82%) patients had freedom from AF at 12 months following ablation. Of these 74 (54%) required post-ablation AAD, 18 (13.5%) required another ablation within the first 12 months and 9 (6.7%) required both AAD and a second ablation to maintain sinus rhythm. There were 14 adverse events (8.6%); 5 access site and 4 non-access site bleeding, 2 strokes, 2 cardiac tamponade and 1 pulmonary vein stenosis with ≈1% serious complications. Conclusion The success of catheter ablation for AF and the incidence of procedure related complications in patients with a history of recent cancer or prior exposure to cardiotoxic therapies are similar to that reported in patients without a history of cancer and hence if needed, it should be considered in select patients. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Dr. S Ganatra is supported by Lahey Physician Research Stipend Program.

scholarly journals Effects of catheter ablation on left atrial performance in different types of atrial fibrillation: a strain study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
E Stefanidis ◽  
K Iliodromitis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Time Course ◽  
Public Institution ◽  
P Value ◽  
Funding Source ◽  
Functional Changes ◽  
Af Recurrence

Abstract Background Atrial structural and functional changes may develop as a result of catheter ablation (CA) in patients with paroxysmal and persistent atrial fibrillation (AF). However, the relation between AF recurrence and atrial performance following CA is still under debate. Our aim is to describe the long-term effects of CA on LA remodeling and its correlates to the maintenance of sinus rhythm (SR). Methods We prospectively enrolled 178 consecutive patients (age: 63±9 years, 35% females) with paroxysmal AF undergoing first-CA (67%) or redo-CA (22%), and 20 individuals (11%) with long-standing persistent AF (PAF) undergoing first CA. All patients underwent comprehensive transthoracic echocardiography at baseline and at 12-month follow-up, including the assessment of reservoir and contractile strain (LAS) using two dimensional speckle tracking echocardiography in all three apical views. The study population was divided in two sub-groups according to AF recurrence during follow-up. Results During one-year follow-up, 144 (81%) patients maintained SR whereas 34 (19%) patients had AF recurrence [first-CA group 16 (13%), redo-CA group 8 (20%) and PAF group 10 (50%)]. Improvement of LAS was observed only in patients with paroxysmal and long-standing persistent AF who underwent the first CA and who remained in SR (Figure 1A, 1C). In contrast, recurrent AF was associated with absence of LAS improvement (Figure 1A, 1C). Different time course of LA performance was observed in the redo-CA group, i.e. LAS remained unchanged from baseline regardless of long-term maintenance of SR (Figure 1B). Moreover, at follow-up, no significant differences in LAS between redo-CA patients with SR versus AF were observed. Of note, in patients with long-standing persistent AF and SR, follow-up LAS increased to values observed in the redo-CA group. Conclusion LA performance following CA is strongly affected by complex interplay between extent of atrial electro-structural remodeling and CA procedure. Repeated wide CA might affects negatively LA compliance and contractility despite SR restoration. Figure 1. Reservoir and contractile LAS at Baseline and 12-month follow-up in the First-CA (1A), the Redo-CA (1B) and the long-standing persistent AF (1C) groups in patients who maintained SR versus patients who had AF recurrence. *p value &lt;0.05 (baseline vs. follow-up). Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).

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