Abstract 1841: Left Atrial Volume From 3-dimensional CT Correlates With Atrial Fibrillation Recurrence Following Ablation

Objective: Recurrence of atrial fibrillation (AF) following ablation is common, and further delineation of prognostic markers is needed. We investigated whether LA volume, which can be accurately obtained from 3-dimensional CT, correlates with AF recurrence. Methods: 73 consecutive patients (52 paroxysmal, 21 persistent) undergoing AF ablation were studied. Follow-up was for a minimum of 9 months, and success was determined by 12-lead EKG and lack of symptoms (unless symptoms proven not AF by Holter). LA volume was calculated by summation of axial CT slices. The left atrial appendage was measured separately. Results: Overall procedure success was 66% including 11 (15%) who had repeat ablations and 9 (12%) who were on antiarrhythmics. Pulmonary vein isolation was performed in all, with additional linear ablation in 44 (60%). The mean (95% CI) LA volume for those with recurrent AF was 119 cc (104, 135) versus 98 cc (90, 106) for no recurrence (p=0.01, rank sum). Wide variation in LA volume was noted in both groups (see box plot). For those patients with a volume >135cc (n=11), 9 (82%) had recurrent AF. No correlation existed between recurrence and type of AF or ablation strategy. Patients who had received a linear ablation had a larger mean LA volume than those who had not (111 cc vs. 97 cc, p=0.03, rank sum). LA appendage volume was not associated with recurrence. Conclusion: LA volume variation is large in both those with and without successful AF ablations. Mean LA volume is significantly larger in those with recurrent AF. Patients with LA volumes >135 cc are very likely to experience recurrent AF. More aggressive ablation strategies may be required in patients with large LA volumes.

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Abstract P025: Left Atrial Dilatation Predicts The Incidence Of Persistent Atrial Fibrillation In Japanese General Population; The Suita Study

Circulation ◽

10.1161/circ.137.suppl_1.p025 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Aya Higashiyama ◽

Makoto Watanabe ◽

Yoshihiro Kokubo ◽

Tomonori Okamura ◽

Akira Okayama ◽

...

Keyword(s):

Atrial Fibrillation ◽

General Population ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Cvd Risk ◽

Japanese General Population ◽

The Mean ◽

The Relationship

Objective: Atrial fibrillation (AF) is an important risk factor for cardiovascular disease (CVD). Left atrial (LA) dilatation detected by ultrasonic cardiography (UCG) has been reported to be associated with the incidence of AF in Western countries. However, the relationship between LA dilatation and the AF incidence has not been well investigated in Asian countries, with lower incidence of AF and obesity and with higher incidence of hypertension and stroke. To investigate the relationship between LA dilatation and the AF incidence in Japanese general population, we estimated the multivariate-adjusted hazard ratios (HR) of LA dilatation assessed by UCG for the incidence of AF. Methods: Participants were 1,585 individuals without AF (665 men, 920 women) who are the participants of a prospective cohort study for CVD incidence in urban Japanese general population (the Suita study). The mean±SD age of the participants were 67.8±7.0 years. Transthoracic UCG was performed from July in 2007 to June in 2013, and LA dimension was determined in accordance with American Society of Echocardiography recommendations by M-mode echocardiograms. After the UCG, the electrocardiograms (ECG) were repeatedly performed until March in 2016. The physicians coded the ECG using Minnesota Code (MC), and AF code is defined as 8-3-1. The HRs of LA dilatation for the incidence of AF with 95% confidence interval (CI) were estimated by Cox proportional hazard model with the adjustment for the followings at the UCG test; age, sex, systolic blood pressure, body mass index, the presence of heavy drinking (more than 2 drinks/day), non-HDL cholesterol, and the presence of the moderate or severe mitral or aortic valve abnormality detected by UCG. Results: The mean follow-up period from UCG to the last ECG was 4.6±1.8 years, and 19 AF incidences were detected. The multivariate-adjusted HR of the LA dilatation (>40 mm) for the incidence of AF was 8.19 (95% CI: 2.47-27.14). And the multivariate-adjusted HR of 5 mm increment of LA dimension was 2.95 (1.65-5.29), and that of the highest quartile of LA dimension compared to the lowest was 3.37 (0.64-17.78). Among 674 participants with left atrial volume index (LAVI) data (5 AF cases), the multivariate-adjusted HR of LAVI ≥ 32 (ml/m 2 ) for AF incidence was 3.93 (95%CI: 0.34-45.86), and it showed the highest HR among the co-adjusted factors. Conclusion: LA diameter assessed by UCG is a simple and non-invasive clinical data, and could be a useful factor for the prediction of AF incidence among Japanese general population. Although the follow-up period was not enough compared to the previous studies in Western population, the present study might indicate that individuals with LA dilation detected by UCG are the important candidate for careful and continuous check-ups about CVD risk factors, ECG and UCG in Asian population.

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Atrial fibrillation progression risk factors and associated cardiovascular outcome in well-phenotyped patients: data from the AF-RISK study

EP Europace ◽

10.1093/europace/euz339 ◽

2019 ◽

Vol 22 (3) ◽

pp. 352-360 ◽

Cited By ~ 7

Author(s):

Ruben R De With ◽

Ernaldo G Marcos ◽

Elton A M P Dudink ◽

Henri M Spronk ◽

Harry J G M Crijns ◽

...

Keyword(s):

Atrial Fibrillation ◽

Standard Deviation ◽

Left Atrial ◽

Left Atrial Volume ◽

Plasminogen Activator Inhibitor 1 ◽

Atrial Volume ◽

Standard Deviation Increase ◽

Recent Onset ◽

Pai 1

Abstract Aims Atrial fibrillation (AF) is a progressive disease, but identifying patients at risk for AF progression is challenging. We aimed to identify factors associated with AF progression. Methods and results Atrial fibrillation progression was assessed in 392 patients with recent-onset paroxysmal or persistent AF included in the prospective, observational, multicentre identification of a risk profile to guide atrial fibrillation (AF-RISK) study. Progression of AF was assessed by Holter monitoring and 2-week event recorder at baseline and 1-year follow-up. AF progression was defined as: (i) doubling in AF burden at 1 year compared to baseline with a minimum AF burden of 10% in paroxysmal AF; or (ii) transition from paroxysmal to persistent or permanent AF; or (iii) persistent to permanent AF. Age was 60 ± 11 years, 62% were men, and 83% had paroxysmal AF. At 1 year, 52 (13%) had AF progression (11% in paroxysmal; 26% in persistent AF). Multivariable logistic regression showed that left atrial volume [odds ratio (OR) per 10 mL 1.251, 95% confidence interval (CI) 1.078–1.450; P < 0.001], N-terminal pro-B-type natriuretic peptide (NT-proBNP; OR per standard deviation increase 1.583, 95% CI 1.099–2.281; P = 0.014), and plasminogen activator inhibitor-1 (PAI-1; OR per standard deviation increase 0.660, 95% CI 0.472–0.921; P = 0.015) were associated with AF progression. In an additional follow-up of 1.9 (0.9–3.3) years patients with AF progression developed more cardiovascular events and all-cause mortality (12.4%/year vs. 2.3%/year, P < 0.001). Conclusion Atrial fibrillation progression occurred in 13% of patients with recent-onset AF during 1-year follow-up. Left atrial volume, NT-proBNP, and PAI-1 were associated with AF progression. Patients with AF progression had a higher event rate. Trial registration number Clinicaltrials.gov NCT01510210.

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A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

10.21203/rs.2.16351/v4 ◽

2019 ◽

Author(s):

Jun Ding ◽

Jing Xu ◽

Wei Ma ◽

Bingwei Chen ◽

Peigen Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Dwell Time ◽

Pulmonary Veins ◽

Group Versus ◽

Conventional Group ◽

Optimal Dosage ◽

Total Procedure Time ◽

The Mean

Abstract Background : The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods: A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 seconds each)(the Cryo-AF Conventional group n=84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of -40°C within 60 seconds (the Cryo-AF Dosing group n=80). Results: We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7±0.8, with no difference between groups (Cryo-AF Conventional , 8.7±0.8 versus Cryo-AF Dosing ,8.6±0.8; P =0.359). The Cryo-AF Dosing group required significantly less total cryotherapy application time (990.60±137.77versus 1501.58±89.60 seconds; P <0.001) and left atrial dwell time (69.91±6.91 versus 86.48±7.03 minutes; P <0.001) than the Cryo-AF Conventional group. Additionally, the Cryo-AF Dosing group required significantly less total procedure time (95.03±6.50 versus 112.43±7.11 minutes; P <0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 minutes. The reconnection rates between the Cryo-AF Conventional and Cryo-AF Dosing groups were similar in that 2.98% and 0.94% of the initially isolated veins were reconnected, respectively, ( P =0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AF Dosing group versus 78.57% in the Cryo-AF Conventional group ( P =0.978). Conclusion: A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

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Abstract 15257: Epicardial and Peri-atrial Fat Attenuation Predict Recurrence in Patients Undergoing Repeat Catheter Ablation for Refractory Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.15257 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mark S Brahier ◽

Fengwei Zou ◽

Frank Migliarese ◽

Milos Tomovic ◽

Alexandra Taylor ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Adipose Tissue ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Volume ◽

Epicardial Fat ◽

Volume Index ◽

Atrial Volume ◽

Af Recurrence

Background: Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation. Methods: The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index. Results: Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors. Conclusions: Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.

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P1580Left atrial volume index predicts improvement in renal function after catheter ablation of atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0340 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Usuda ◽

T Kato ◽

H Furusho ◽

H Tokuhisa ◽

T Tsuda ◽

...

Keyword(s):

Renal Function ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

The Mean ◽

Recurrence Group

Abstract Background Atrial fibrillation (AF) increased the risk of development of kidney disease. The elimination of AF by catheter ablation is associated with improvement in renal function. However, the mechanism of cardio-renal interaction in AF has not been fully elucidated. Purpose We tested the hypothesis that left atrial volume index (LAVI), which is a marker of left atrial mechanical reserve, predicts improvement in renal function after restoring sinus rhythm with catheter ablation of AF. Methods We analyzed consecutive patients who underwent catheter ablation of AF from January 2012 to October 2018 and had completed follow-up more than 3 months after catheter ablation. Exclusion criteria were need for hemodialysis and acute hospitalization. Estimated glomerular filtration rate (eGFR) was assessed on admission and at the end of follow-up periods after catheter ablation and the difference was defined as ΔeGFR. Left atrial volume index was derived using the biplane area-length method. Results A total of 159 AF patients (paroxysmal 112 [70%], persistent 47 [30%]) were included in this study. The mean age was 65±11 years and 74% were male. During the mean follow-up period of 7.9±3.2 months, 105 patients (66%) were free from atrial tachyarrhythmias and 54 (34%) experienced the recurrence. Baseline eGFR and LAVI were not significantly different between the non-recurrence group and the recurrence group (71.0±17.4 and 75.1±22.8 mL/min/1.73m2; p=0.24, 35.7±12.5 and 37.9±15.0 ml/m2; p=0.34). ΔeGFR in the non-recurrence group was significantly greater compared with the recurrence group (+1.5±1.0 versus −4.3±1.4 mL/min/1.73m2; p=0.001). Baseline LAVI was negatively correlated with ΔeGFR in the non-recurrence group (r=−0.3; p=0.002; Figure), but not in the recurrence group (p=0.1). Multiple regression analysis in the non-recurrence group identified baseline LAVI (β=−0.35, p<0.001), baseline age (β=−0.31, p<0.001) and baseline eGFR (β=−0.59, p<0.001) as independent predictors for eGFR improvement after catheter ablation. In the patients with LAVI <34 ml/m2, age <70 years and eGFR <90 mL/min/1.73m2, the mean ΔeGFR was +6.3±1.9 mL/min/1.73m2. Figure 1 Conclusions LAVI, a marker of left atrial mechanical reserve, was an independent predictor of improvement in renal function after restoring sinus rhythm with catheter ablation of AF. This observation suggests that AF-related deterioration of renal function is due at least in part to impaired atrial mechanical function.

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Results of the Thoracoscopic Radiofrequency Epicardial Ablation with a Bipolar Electrode During Longstanding Persistent form of Atrial Fibrillation

E3S Web of Conferences ◽

10.1051/e3sconf/202015908007 ◽

2020 ◽

Vol 159 ◽

pp. 08007

Author(s):

Rustem Tuleutaev ◽

Alibek Oshakbayev ◽

Kuat Abzaliyev ◽

Baurzhan Rakishev ◽

Symbat Abzaliyeva

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Bipolar Electrode ◽

Epicardial Ablation ◽

Input And Output ◽

Mean Size ◽

The Mean ◽

Β Blockers

Thoracoscopic ablation using the ‘box lesion’ technique was performed using a bipolar radio frequency clamp. A total of 48 patients, including 38 men and 10 women, mean age 58 years (range 33 74). The mean duration of AF was 4 yrs (range 1.5 months 21), the mean size of the atrium 4.15 ± 0.9 cm (2.9-8.8 cm), mean LVEF was 57.7% (39 -73%). Mitral regurgitation of 1-2 degrees was present in 14 patients, EDV LV 147.7 ml (81-224). Primary catheter ablation was performed in 22 patients, where 5 of them (22,7%) were performed repeatedly. Resection of the left atrial appendage (LAA) during the operation was performed in 44 patients (91%). Input and output block was achieved in all patients. In the postoperative period, all patients were administered supporting antiarrhythmic therapy with amiodarone and β-blockers, anticoagulant therapy with warfarin or PLA for 6-12 months. The effectiveness of treatment was monitored by a cardiomonitor Reveal XT in the period 1, 3, 6, 12, 24 months after surgery, the mean follow-up length was 498 ± 19 days. Sinus rhythm was restored during surgery in all patients and remained until discharge.

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Atrial fibrillation recurrence after transcatheter ablation worsens left atrial strain

European Heart Journal ◽

10.1093/ehjci/ehaa946.0137 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Annunziata ◽

F Notaristefano ◽

L Spighi ◽

S Piraccini ◽

G Giuffre' ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrial ◽

Left Atrial Strain ◽

Systolic Volume ◽

End Systolic Volume ◽

Atrial Strain ◽

Af Recurrence

Abstract Introduction Left atrial strain (LAs) shows correlation with atrial fibrosis and is a predictor of atrial fibrillation (AF) recurrence after transcatheter ablation. Little is known about LAs evolution after ablation. Purpose We sought to evaluate the atrial function with echocardiographic strain before and 6 months after AF ablation. Methods 65 consecutive patients undergoing radiofrequency or cryoballoon ablation for atrial fibrillation at our centre were enrolled. They underwent a transthoracic echocardiography before the procedure and at 6 months follow-up. 5 patients were excluded because of low quality images. Global left atrial strain during the reservoir phase (LASr) was calculated as a mean of the values obtained in 4 and 2 chamber apical view; the ventricular end-diastole was set as reference to allow the calculation both in patients in AF and sinus rhythm during the echocardiography. Recurrence was defined as any atrial arrhythmia episode lasting more than 30 seconds recorded on an EKG strip after the 3 months blanking period; all patients underwent a 24 hours EKG Holter after the blanking period to detect asymptomatic recurrence. Quality of life was assessed before the procedure and at follow-up with the EQ-5D-3L model. Results At 6 months 14 patients (13%) had AF recurrence. Patients with recurrence (AF-R) had similar baseline characteristics compared to those without recurrence (AF-NR) but the former had a longer history of AF (39±53 vs 85±94 months, p=0,018). LASr, LA volume and left ventricle ejection fraction (EF) were similar at baseline between groups. At follow-up LASr was significantly impaired in the AF-R group compared to AF-NR (14±6% vs 26±10% respectively, p<0,0001) whereas LA volume, LV end systolic volume and EF remained similar. Compared to baseline LASr worsened in patients experiencing AF recurrence (22±11% vs 14±6%, p=0.016) and this finding was consistent also in patients in sinus rhythm during both examinations (29±8 vs 17±7, p=0,005). Compared to baseline LASr (22±10% vs 26±10%, p=0.024), LV end-systolic volume (29±15 ml vs 22±6 ml, p=0,006) and EF (51±9% vs 58±18%, p=0,038) improved in the AF-NR group but the effect was driven mainly by patients restoring sinus rhythm. Both groups showed a significant improvement of the quality of life (55±23 vs 85±13, p<0,0001 AF-NR; 63±17 vs 80±12, p=0,012 AF-R). Conclusions Atrial fibrillation recurrence after transcatheter ablation is associated with significant left atrial strain worsening which indicates disease progression and may predispose to further long-term recurrences whereas a successful ablation has a protective effect on atrial function. Funding Acknowledgement Type of funding source: None

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Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings from the CABANA Imaging Substudy

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.008540 ◽

2021 ◽

Author(s):

Maryam E. Rettmann ◽

David R. Holmes III ◽

Kristi H. Monahan ◽

Jerome F. Breen ◽

Tristram D. Bahnson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Drug Therapy ◽

Catheter Ablation ◽

Clinical Outcomes ◽

Primary Endpoint ◽

Left Atrial ◽

Volume Index ◽

The Relationship ◽

Af Recurrence

Background - The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial was a randomized, prospective trial of left atrial catheter ablation versus drug therapy for treatment of atrial fibrillation (AF). As part of CABANA, a prospective imaging sub-study was conducted. The main objectives were to describe the patterns of changes in the dimensions of the left atrium (LA) and pulmonary veins (PVs), and the relationship between these changes with treatment assignment and clinical outcomes. Methods - CT or MRI was acquired at baseline and follow-up in 121 ablation (median follow-up 101 days) and 85 drug patients (median follow-up 97 days). Left atrial volume index (LAVI), mean PV ostial diameter (MPV) , and ostial diameters of each PV separately were computed. We examined the relationship between the change from baseline to follow-up with subsequent clinical outcomes (composite of death, disabling stroke, serious bleeding, or cardiac arrest [CABANA primary endpoint], total mortality or cardiovascular hospitalization, first AF recurrence after the 90 day blanking period, first AF/atrial flutter/ atrial tachycardia after the 90 day blanking period) using Cox proportional-hazards models. Results - The median (25 th , 75 th ) change from baseline for LAVI was -7.8 mL/m 2 (-16.4, 0.2), ablation arm and -3.5 mL/m 2 (-11.4, 2.6), drug therapy arm. The LAVI decreased in 52.9% of ablation patients versus 40.0% of drug therapy patients. Change for MPV was -2.7 mm (-4.2, -1.3) in the ablation arm versus -0.1 mm (-1.5, 0.8) in the drug therapy arm. Changes in LA and PV dimensions had no consistent relationship with the risk of developing the study primary endpoint. Reductions in LAVI, and in MPV diameter were associated with decreased risk of AF recurrence. Conclusions - Ablation patients demonstrated more frequent and larger atrial structural changes compared with drug patients. These changes suggest a critical relationship between structural features and AF generation.

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A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

10.21203/rs.2.16351/v2 ◽

2019 ◽

Author(s):

Jun Ding ◽

Jing Xu ◽

Wei Ma ◽

Bingwei Chen ◽

Peigen Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Dwell Time ◽

Pulmonary Veins ◽

Group Versus ◽

Conventional Group ◽

Optimal Dosage ◽

Total Procedure Time ◽

The Mean

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The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.677885 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shiyu Gong ◽

Jian Zhou ◽

Bingyu Li ◽

Sheng Kang ◽

Xiaoye Ma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Recurrence Rate ◽

Morphological Feature ◽

Left Atrial ◽

Left Atrial Appendage ◽

Recurrence Risk ◽

Atrial Appendage ◽

Af Recurrence

Objective: The probability of late recurrent atrial fibrillation (AF) after radiofrequency ablation (RFA) has not yet been fully clarified. This study aims to study the association of left atrial appendage (LAA) morphology with AF recurrence after RFA.Methods: We retrospectively enrolled 84 patients (24 patients had persistent AF, 60 patients had paroxysmal AF) who underwent RFA in Shanghai East Hospital from June 2014 to May 2018. The mean follow-up of these patients was 618.6 days. According to preoperative transesophageal echocardiography (TEE), the morphology feature of LAA was classified and evaluated by two classification methods. The first method was divided into chicken-wing, windsock, cactus, and cauliflower, and the second method was divided into one lobe, two lobes, and multiple lobes. The correlation between morphological feature of LAA and the recurrence rate of AF after RFA was analyzed.Results: During follow-up, 12 patients (50%) and 10 patients (16.7%) had AF recurrence in persistent and paroxysmal AF, respectively. The LAA morphology was associated with the recurrence of AF after RFA with the chicken-wing highest recurrence risk (68.2%). The structure type of LAA was also related to the AF recurrence rate (p < 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p < 0.02). Logistic regression analysis showed that the chicken-wing group had a higher risk of recurrence after RFA (OR = 8.13, p = 0.004), and the windsock group had a lower risk of recurrence (OR = 0.17, p = 0.002).Conclusion: The morphological feature of LAA is related to the recurrence risk of AF after RFA. LAA morphology assessment can predict the risk of AF recurrence.

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