scholarly journals Left Atrial Appendage Circular RNAs Are New Predictors of Atrial Fibrillation Recurrence After Surgical Ablation in Valvular Atrial Fibrillation Patients

2021 ◽  
Vol 24 (6) ◽  
pp. E968-E976
Author(s):  
Xiyu Zhu ◽  
Yali Wang ◽  
Ran Mo ◽  
Hoshun Chong ◽  
Cailong Cao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Model ◽  
Left Atrial Appendage ◽  
Late Recurrence ◽  
Circular Rnas ◽  
Surgical Ablation ◽  
Kaplan Meier ◽  
Independent Risk Factors ◽  
Af Recurrence

Background: Atrial fibrillation (AF) recurrence after ablation will increase mortality and morbidity during follow up. We attempted to evaluate the relationship between circular RNAs (circRNA) and AF recurrence to establish a predictive model for early intervention. Methods: Patients who received surgical ablation retrospectively were analyzed. The expression of circRNAs were detected in the left atrial appendage. The independent risk factors of late recurrence were analyzed by multivariate analysis. The predictive model was visualized by Nomogram and tested by receiver operating characteristic curve and calibration plot. Kaplan-Meier plot was used to compare the rate of freedom from AF recurrence after surgery. The relationships between circRNAs and clinical characteristics were detected by Spearman’s correlation analysis. Results: A total of 136 patients were enrolled from September 2018 to June 2019, 55 patients experienced late recurrence during one-year follow up. Increased age, longer AF duration and increased circ 81906-RYR2, circ 44782-LAMA2, circ 418-KCNN2 and circ 35880-ANO5 were detected in recurrent patients. Multivariate analysis revealed that increased age (odds ratio (OR)=1.072, P = 0.006), longer AF duration (OR=1.007, P = 0.036) and increased circ 81906-RYR2 (OR=2.210, P < 0.001) were independent risk factors for late recurrence. Area under the curve was 0.77, and the cut-off value was 70 points of the predictive model. Kaplan-Meier plots showed that patients over 70 points tended to experience AF recurrence. Conclusion: Circ 81906-RYR2 could be a new predictor of late recurrence after surgical ablation. A predictive model consists of age, atrial fibrillation duration, and circ 81906-RYR2 was alternative for early intervention of AF recurrence.

scholarly journals Left Atrial Appendage Circular RNAs Are New Predictors of Atrial Fibrillation Recurrence After Surgical Ablation in Valvular Atrial Fibrillation Patients: a Case Control Study

2021 ◽  
Author(s):  
Xiyu Zhu ◽  
Yali Wang ◽  
Ran Mo ◽  
Hoshun Chong ◽  
Hailong Cao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Model ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Circular Rnas ◽  
Atrial Fibrillation Recurrence ◽  
Surgical Ablation ◽  
Kaplan Meier

Abstract Background: Atrial fibrillation recurrence after surgical ablation in valvular atrial fibrillation patients will increase the mortality and morbidity during follow-up. In this study, we attempted to evaluate the relationship between circular RNAs in left atrial appendage and atrial fibrillation recurrence to establish a predictive model for early intervention.Methods: A retrospective case control study of all patients who underwent surgical ablation during valve surgery was performed. The expression level of circular RNAs were detected in the left atrial appendage tissue after surgery. 24 hours Holter examination was used to evaluate the status of heart rhythm during follow-up. The independent risk factors of atrial fibrillation recurrence were analyzed by multivariate analysis. The predictive model of atrial fibrillation recurrence was visualized by Nomogram and was tested by receiver operating characteristic curve analysis. Kaplan-Meier analysis was performed to compare the rate of freedom from atrial fibrillation recurrence after surgery.Results: A total of 136 patients completed the research strategy from September 2018 to June 2019, 81 (59.6%) patients restored sinus rhythm and 55 (40.4%) patients experienced atrial fibrillation recurrence. Increased age (P=0.002), longer AF duration (P<0.001) and increased expression of circ 81906-RYR2 (P<0.001), circ 44782-LAMA2 (P=0.002), circ 418-KCNN2 (P=0.011) and circ 35880-ANO5 (P<0.001) were detected in atrial fibrillation recurrence group. Multivariate analysis revealed that increased age (odd ratio=1.072, P=0.006), longer AF duration (odd ratio=1.007, P=0.036) and increased expression of circ 81906-RYR2 (odd ratio=2.210, P<0.001) were independent risk factors for recurrence. The area under the curve was 0.77 and the cut-off value was 70 points of the predictive model. The results of Kaplan-Meier plots showed that patients over 70 points were more likely to suffer from atrial fibrillation recurrence during the follow-up.Conclusions: Circ 81906-RYR2 could be a new predictor of atrial fibrillation recurrence after surgical ablation. A predictive model consists of age, atrial fibrillation duration and expression of circ 81906-RYR2 was alternative for early intervention of atrial fibrillation recurrence.Trial registration: Retrospectively registered.

scholarly journals The preablation monocyte/ high density lipoprotein ratio predicts the late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
She-an Chen ◽  
Man-man Zhang ◽  
Meifang Zheng ◽  
Fei Liu ◽  
Lei Sun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
High Density Lipoprotein ◽  
Predictive Value ◽  
Density Lipoprotein ◽  
Late Recurrence ◽  
High Density ◽  
Significant Difference ◽  
Af Recurrence

Abstract Background The monocyte/high-density lipoprotein ratio (MHR) has emerged as a promising alternative biomarker in the fields of cardiovascular disease and atrial fibrillation (AF). This retrospective study was aimed to explore the predictive value of the MHR for the late recurrence of AF after radiofrequency ablation. Methods From April 2015 to October 2018, patients with paroxysmal AF who had undergone radiofrequency catheter ablation at Subei People’s Hospital of Jiangsu Province were enrolled in our study. All the participants were observed until November 2019 after the procedure. During the postoperative follow up, the patients were categorized into the recurrence group and maintenance of sinus rhythm group based on who had experienced AF recurrence. Results One hundred twenty-five patients were diagnosed with paroxysmal AF, with an average age of 61.2 ± 9.3 years. Forty-seven patients had developed late recurrence during a mean follow up of 25.1 ± 12.0 months. The AF recurrence event rates were significantly increased in the highest MHR tertile compared with those in the lowest MHR tertile (22.0% vs. 57.1%; P < 0.05). On multivariate logistic regression analysis, the preablation MHR (OR = 1.34; 95% CI = 1.12 ~ 1.60; P = 0.001) and left atrial diameter (LAD) (OR = 1.21, 95% CI = 1.08 ~ 1.35; P = 0.001) were independent risk factors predicting the recurrence of AF after radiofrequency ablation. Furthermore, receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the MHR was 0.712 (95% CI = 0.618 ~ 0.806; P = 0.000) and that of LAD was 0.739 (95% CI = 0.653 ~ 0.814; P = 0.000). Z-test found no significant difference between the MHR and LAD regarding the AUC (Z = 0.451; P = 0.652). Conclusion An elevated preablation MHR was associated with an increased risk of the postoperative recurrence of AF. Additionally, the MHR independently predicted the late recurrence of paroxysmal AF after radiofrequency ablation, with the same predictive value as LAD.

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

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 &lt; 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p &lt; 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.

Abstract 19348: Efficacy of Cryoballoon Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Emily Guhl ◽  
Donald Siddoway ◽  
Evan Adelstein ◽  
Samir Saba ◽  
Andrew Voigt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation ◽  
Free Survival ◽  
Kaplan Meier ◽  
Initial Strategy ◽  
Free Rate ◽  
Af Recurrence

Introduction: Cryoballoon pulmonary vein isolation (PVI) has emerged as an alternative to radiofrequency PVI for the treatment of paroxysmal atrial fibrillation (AF). The optimal ablation strategy for patients with persistent AF is unclear, as data on Cryoballoon PVI alone are limited. Methods: We analyzed a prospective registry of consecutive patients with persistent AF who underwent Cryoballoon PVI at a single center between 2011 and 2014. Patients were assessed for AF recurrence (including any atrial arrhythmia) after a 3 month blanking period at 6 months, 1 year, 2 years, and as needed for symptoms post PVI. Recurrence was based on typical symptoms or ECG/ event monitor evidence of AF. Kaplan-Meier analysis was used to estimate AF-free survival. Results: The 69 patients who underwent Cryoballoon PVI were aged 59 ± 8 years, 86% male, 54% HTN, had a CHADS2-VASC score 1.6 ± 1.2, and had a LA dimension 4.5 ± 0.6 cm. The AF recurrence-free rate at 1-year post-procedure was 59%. Overall, AF-free survival was 50% at the mean follow-up of 607 days. In comparing patients with persistent AF duration <1 year vs. >1 year, there was a trend toward greater AF recurrence-free rates in the <1 year group (66% vs 55%, p=0.09) Conclusions: Cryoballoon PVI appears to be an effective initial strategy in treating persistent AF, with an AF recurrence-free rate of 59% at 1 year.

scholarly journals Influence of characteristics of epicardial adipose tissue and myocardial sympathetic innervation on the development of late recurrence of atrial fibrillation after radiofrequency ablation

2021 ◽  
Vol 26 (12) ◽  
pp. 4788
Author(s):  
Yu. V. Varlamova ◽  
S. I. Sazonova ◽  
E. V. Popov ◽  
R. E. Batalov ◽  
T. V. Moskovskikh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sympathetic Activity ◽  
Epicardial Adipose Tissue ◽  
Sympathetic Innervation ◽  
Late Recurrence ◽  
Washout Rate ◽  
Myocardial Sympathetic Innervation ◽  
Recurrence Group ◽  
Af Recurrence

Aim. To investigate the relationship between radiological characteristics of epicardial adipose tissue (EAT) and myocardial sympathetic activity, as well as to study their association with late recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA).Material and methods. This prospective study included 26 people with persistent and long-standing persistent AF scheduled for interventional AF treatment. Before the RFA procedure, all patients underwent cardiac 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy to assess the myocardial sympathetic innervation and contrast-enhanced cardiac multislice computed tomography to assess pulmonary vein anatomy, left atrial volume, and EAT volume. Clinical follow-up, including 12-lead electrocardiography (ECG) and 24-hour ECG monitoring, was carried out 3, 6 and 12 months after RFA.Results. After the end of follow-up, the patients were divided into two groups: with AF recurrence (group 1, n=8) and without AF recurrence (group 2, n=18). Multivariate logistic analysis found that only the 123I-MIBG washout rate (odds ratio, 1,0943; 95% confidence interval, 1,0138-1,1812) proved to be an independent predictor of late AF recurrence after RFA. ROC analysis revealed that a 123I-MIBG washout rate >21% with a sensitivity of 75% and a specificity of 83,3% (AUC=0,844; p<0,001) predicts late AF recurrence after RFA.Conclusion. Parameters of myocardial sympathetic activity, assessed by 123I-MIBG myocardial scintigraphy, are associated with late AF recurrence after RFA in patients with persistent and long-standing persistent AF. There were no reliable data confirming associations between myocardial sympathetic innervation and radiological EAT indicators, as well as the effect of the latter on the risk of AF recurrence after RFA.

scholarly journals The Predictive Value of left atrial appendage peak flow velocity in Recurrence after initial radiofrequency catheter ablation of persistent atrial fibrillation: A single-center prospective study.

2021 ◽  
Author(s):  
Wentao Yang ◽  
Qing Zhao ◽  
Minghui Yao ◽  
Xiangdong Li ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Flow Velocity ◽  
Left Atrial ◽  
Radiofrequency Catheter Ablation ◽  
Left Atrial Appendage ◽  
Peak Flow ◽  
Persistent Atrial Fibrillation ◽  
Af Recurrence

Background: Recurrence after Radiofrequency catheter ablation（RFCA） of persistent atrial fibrillation (PeAF) is still elusive. The present study aimed to evaluate the relationship between the left atrial appendage peak flow velocity(LAAV) and atrial fibrillation(AF) recurrences in PeAF patients after their initial RFCA. Method: This study included 164 consecutive PeAF patients who performed initial RFCA from January 2018 to December 2019. Transesophageal echocardiography was used to collect the LAAV before ablation. Patients’ demographic and clinical information was gathered. To detect the recurrences of AF, patients were checked up at routine intervals. A Cox proportional hazards regression analysis was adopted to evaluate the LAAV and other clinical variables as predictors of AF recurrences throughout follow-up. Results: AF recurrence resulted in 43 (26.2%) patients after a median follow-up of 15 months (IQR: 12-18 months). LAAV reduced in patients with AF recurrences (0.36±0.15m/s vs. 0.45±0.17m/s, P = 0.004). A Kaplan-Meier study revealed that the low LAAV(≤0.37m/s) group had a lower event-free survival rate than the high LAAV (>0.37m/s) group (17.6 months vs. 21.2 months, Log Rank P = 0.002). LAAV≤0.37m/s (HR 2.32, 95%CI 1.177-4.227, P = 0.014) was found to be independent predictors of AF recurrence after RFCA in the multivariate Cox regression. Conclusion: A low LAAV is linked to AF recurrence and acts as a predictor of AF recurrence after the initial RFCA of peAF. This would aid in treatment strategy optimization and management of patients with peAF.

scholarly journals A novel predictive model of recurrence after surgical ablation of valvular atrial fibrillation

2021 ◽  
Author(s):  
Yali Wang ◽  
Xinlong Tang ◽  
Adili Ailiya ◽  
Can Xu ◽  
Xiyu Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Predictive Model ◽  
Early Recurrence ◽  
Function Parameter ◽  
Valvular Surgery ◽  
Risk Predictors ◽  
Af Recurrence

Background: Radiofrequency ablation(RFA) has emerged as a common approach to treatment of atrial fibrillation(AF) coupled with valve surgery. However, risk factors were rarely reported on recurrence after RFA of valvular atrial fibrillation . Methods: Retrospective study of a single-center database was performed in patients underwent valvular surgery combined with radiofrequency ablation. Follow-up was conducted from 3 months to 1 year after procedure. AF recurrence was defined as any episode of atrial arrhythmia lasting more than 30 seconds. Risk factors were analysis using Logistic regression and a predictive model was established. Results: 3-month follow-up was completed in 319 patients, 195 patients (61.1%) had AF recurrence. During the 1-year follow-up, 74 /166 patients(44.6%) had AF recurrence. Compared with sinus rhythm maintenance group, overweight(p=0.022), high BMI(p=0.024), large preoperative LAD(p<0.001), small MI area(p=0.019), large MI diameter(p<0.001) and other liver function parameter like low ALT level(p=0.023), high total bilirubin(p=0.013) and direct bilirubin level(p=0.033) were significantly correlated with AF recurrence after RF. In multivariate analysis, BMI(OR 1.12, 95% CI 1.04-1.21, p=0.003), LAD(OR 1.49, 95% CI 1.09-2.07, p=0.015), MI area(OR 0.41, 95% CI 0.18-0.85, p=0.023), MI diameter(OR 2.45, 95% CI 1.16-5.34, p=0.021), ALT(OR 0.98, 95% CI 0.97-0.99, p=0.002) and eGFR(OR 1.01, 95% CI 1.09-1.02, p=0.042) were significantly independent risk predictors of AF early recurrence. A predictive model was created with AUC of 0.720. Conclusions: BMI、LAD、MI area、MI diameter、ALT and eGFR were risk predictors of AF early recurrence. We established a predictive model and it devote to preoperative clinical health management of individual with valvular AF.

Reduced Incidence of Thromboembolic Events after Surgical Closure of Left Atrial Appendage in Patients with Atrial Fibrillation

2016 ◽  
Vol 11 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Manuel Wilbring ◽  
Friedrich Jung ◽  
Christoph Weber ◽  
Klaus Matschke ◽  
Michael Knaut
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Thromboembolic Events ◽  
Surgical Ablation ◽  
Closure Group ◽  
Laa Closure

Objective Most of the detected thrombi in patients with atrial fibrillation (AF) can be found in the left atrial appendage (LAA). Interventional LAA closure recently proved to be noninferior to warfarin therapy. Whether these results can be fully translated into surgical LAA closure remains unclear. Corresponding data are still lacking. The present observational study evaluated the impact of surgical LAA closure in patients with AF undergoing cardiac surgery on postoperative thromboembolic events. Methods A prospective registry enrolled 398 patients with permanent AF undergoing cardiac surgery. Concomitant procedures were isolated surgical ablation (group I, n = 71), isolated LAA closure (group II, n = 44), and combined surgical ablation and LAA closure (group III, n = 196). The control group consisted of 87 patients without concomitant surgical ablation or LAA closure. One-year follow-up was completed in all patients. End points were thromboembolic events and death from any cause. Results Clinical baseline characteristics were comparable among the groups. General hospital mortality was 5.5% and likewise differed not significantly. Postoperatively, mean (SD) CHAD2S2-VASc score of 3.5 (1.3) differed not significantly among the groups, indicating comparable thromboembolic risk. Follow-up referred to all hospital survivors (n = 376). Herein, overall incidence of thromboembolic events was 9.8% (n = 37), with an associated mortality of 41.0%. Patients with LAA closure alone or in combination with surgical ablation had a significantly reduced incidence of thromboembolic events (6.6% vs 20.5%, P < 0.01) and consecutively improved survival after 1 year of follow-up (7.0% vs 17.1%, P < 0.01). Conclusions Left atrial appendage closure alone or in combination with surgical ablation was associated with a significantly reduced rate of thromboembolic events and consecutively improved survival after 1 year of follow-up.

scholarly journals The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation

2021 ◽  
Vol 10 (21) ◽  
pp. 4863
Author(s):  
Denise Guckel ◽  
Khuraman Isgandarova ◽  
Leonard Bergau ◽  
Misagh Piran ◽  
Mustapha El Hamriti ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Single Shot ◽  
Atrial Tachyarrhythmia ◽  
Kaplan Meier ◽  
Af Recurrence

Diabetes mellitus (DM) plays a crucial role in the regulation of atrial fibrillation (AF). This study aimed to evaluate the outcome of pulmonary vein isolation (PVI) using a single-shot device in patients with AF and DM. A total of 531 consecutive patients undergoing initial cryoballoon (CB)-guided PVI were evaluated. Two hundred eighty-one patients (53%) suffered from paroxysmal AF (PAF; mean age 51 ± 23.2 years, 26% female), 250 patients (48%) from persistent AF (PERS; 64 ± 10.0 years old, 30% female) and 80 patients (15%) were diagnosed with coincidental DM (68 ± 19.6 years old, 30% female). Follow-up visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of atrial tachyarrhythmia. AF recurrence occurred in 26% (140 patients). PAF patients with DM presented with a significantly higher risk for arrhythmia recurrence (Kaplan Meier analysis; Log rank p < 0.001 *). Multivariate analyses found DM to be an independent predictor (IP) for AF recurrence (p = 0.009 *, hazard ratio (HR) 4.363, confidence interval (CI) 1.456–13.074). In PERS, DM was associated with a 43% increase in AF recurrence (p = 0.320, HR 1.427, CI 0.707–2.879). DM has relevant effects on AF recurrence after PVI-only ablation approaches for AF. Major differences were observed in PAF as DM seems to favor the development of individual arrhythmia substrate, which is usually not yet present in PAF. In PERS, DM effects are less pronounced as individual fibrosis has already developed. Thus, personalized paths addressing individual arrhythmia substrates are needed in this specific cohort of patients.

scholarly journals Significance of mitral L wave to predict late recurrence of atrial fibrillation after radiofrequency catheter ablation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Wada ◽  
M Shinohara ◽  
S Yao ◽  
K Yano ◽  
K Akitsu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Late Recurrence ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Recurrent Atrial Fibrillation ◽  
Af Recurrence

Abstract Background Mitral L wave, prominent mid-diastolic filling wave in echocardiographic examinations, is associated with severe left ventricular diastolic dysfunction, and that has been reported to predict recurrent atrial fibrillation (AF) after cardioversion. However, association between mitral L wave and the outcome of AF after radiofrequency catheter ablation (RFCA) has not been established. Objective The aim of this study is to evaluate the predictive value of mitral L wave on AF recurrence after RFCA. Methods 250 patients including 164 paroxysmal AF (65.6%) and 86 non-paroxysmal AF (34.4%) who received RFCA in single center from January 2015 to December 2016 were enrolled consecutively. Echocardiographic examinations before RFCA were recorded, and the mitral L wave was defined as a distinct mid-diastolic flow velocity with a peak velocity ≥20 cm/s following the E wave. Systematic follow-up was conducted after RFCA. Univariate and multivariate analyses were carried out to determine the factors predicting late recurrence of AF (LRAF) which means AF recurrence after 3 months. Enrolled patients were divided into groups with the L wave (L-group; n=57) or without the L wave (NL-group; n=193) based on the findings of echocardiographic examinations. Results During a follow-up of 35.0±17.6 months, the ratio of LRAF in the L-group was significantly higher than that in the NL-group (32 (56.1%) vs. 41 (21.2%), Hazard ratio [HR]: 3.55, 95% confidence interval [CI]: 2.33 - 5.42, p&lt;0.001). Among the clinical factors, presence of mitral L wave, BNP value, non-paroxysmal AF and moderate-severe mitral regurgitation were related to LRAF. A multivariate analysis using a Cox proportional hazard model found that presence of mitral L wave (HR: 2.67, 95% CI: 1.30 - 5.48, p=0.007) was significantly associated with LRAF. Conclusion This study revealed that mitral L wave predicts late recurrence of AF after RFCA. FUNDunding Acknowledgement Type of funding sources: None.

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