Heart and Vessels
Heterogeneity in the left atrial wall thickness contributes to atrial
brillation recurrence after catheter ablation
· Tamotsu Sakamoto
· Yoshiaki Yamaguchi
· Yasushi Tsujino
· Naoya Kataoka
Received: 15 March 2018 / Accepted: 1 June 2018
© Springer Japan KK, part of Springer Nature 2018
Inﬂuence of left atrial wall thickness on outcome of catheter ablation for atrial ﬁbrillation (AF) is unclear. Overall, 213
patients with AF (128 paroxysmal and 85 persistent) received ablation. We measured the wall thickness of 16 and 19 areas
in the pulmonary vein antrum (PVWT) and left atrial body (LAWT), respectively. Coeﬃcient of variation of wall thickness
(CV-WT) was calculated to assess heterogeneity in the left atrial wall thickness. In patients with paroxysmal AF, maximum
PVWT, mean PVWT, maximum LAWT, and CV-WT were higher in AF recurrent group than in AF-free group (maximum
PVWT, 2.85 ± 0.52 vs. 2.50 ± 0.45 mm, P = 0.003; mean PVWT, 1.59 ± 0.13 vs. 1.50 ± 0.15 mm, P = 0.018; maximum
LAWT, 3.85 ± 0.77 vs. 3.41 ± 0.61 mm, P = 0.005; CV-WT, 0.34 ± 0.06 vs. 0.32 ± 0.05, P = 0.039). In patients with persis-
tent AF, maximum PVWT, mean PVWT, maximum LAWT, mean LAWT, and CV-WT were higher in the AF-recurrent
group than in the AF-free group (maximum PVWT, 2.52 ± 0.36 vs. 2.31 ± 0.36 mm, P = 0.031; mean PVWT, 1.53 ± 0.12
vs. 1.45 ± 0.14 mm, P = 0.036; maximum LAWT, 3.68 ± 0.75 vs. 3.11 ± 0.50 mm, P < 0.001; mean LAWT, 2.34 ± 0.35 vs.
2.13 ± 0.21 mm, P = 0.002; CV-WT, 0.35 ± 0.06 vs. 0.31 ± 0.05, P = 0.005). Thick and heterogeneous left atrial wall con-
tributes to AF recurrence after ablation.
Keywords Atrial ﬁbrillation · Atrial arrhythmia · Catheter ablation · Atrial wall thickness · Pulmonary vein isolation
Atrial ﬁbrillation (AF) increases morbidity and mortality
by causing thromboembolism and heart failure , thereby
necessitating the treatment of AF, which is one of the
most critical issues in public health. Recent technological
advancements have enhanced the eﬃcacy of catheter abla-
tion for AF, making it one of the primary treatments for AF.
However, predictors of AF recurrence after ablation remain
Some studies [2–4] have suggested that the left atrial
wall thickness is an essential determinant of AF recurrence
after ablation. In addition, the left atrial wall thickness is
a predictor of reconnection and dormant conduction after
pulmonary vein isolation [3, 4]. Hence, the thick left atrial
wall increases AF recurrence by hindering the creation of
the transmural and durable lesion.
Some other studies [2, 5] have reported that the left atrial
wall thickness changes with the progression of AF. Notably,
the left atrial wall thickness of paroxysmal AF is higher than
that of healthy subjects , suggesting the potential role of
atrial hypertrophy in AF occurrence. Furthermore, the left
atrial wall thickness in patients with persistent AF is lower
than that of patients with paroxysmal AF , suggesting that
the loss of atrial kick and consequent atrial volume overload
might decrease the left atrial wall thickness.
Thus, the left atrial wall thickness is not only the determi-
nant of the creation of a durable lesion but also an indicator
of atrial structural remodeling. Consequently, the impact of
the left atrial wall thickness on the eﬃcacy of ablation might
diﬀer between patients with paroxysmal and persistent AF.
Furthermore, few studies have investigated the inﬂuence of
heterogeneity in the left atrial wall thickness on the eﬃcacy
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0038 0-018-1200-y) contains
supplementary material, which is available to authorized users.
* Yosuke Nakatani
Second Department of Internal Medicine, University
of Toyama, 2630 Sugitani, Toyama 930-0194, Japan