Atrial substrate underlies the recurrence after catheter ablation in patients with atrial fibrillation

Yong Soo Baek, Jong Il Choi, Yun Gi Kim, Kwang No Lee, Seung Young Roh, Jinhee Ahn, Dong Hyeok Kim, Dae In Lee, Sung Ho Hwang, Jaemin Shim, Jin Seok Kim, Dae Hyeok Kim, Sang Weon Park, Young Hoon Kim

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7 Citations (Scopus)


Prediction of recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. We sought to investigate the long-term outcomes after AF catheter ablation. A total of 2221 consecutive patients who underwent catheter ablation for symptomatic AF were included in this study (mean age 55 ± 11 years, 20.3% women, and 59.0% paroxysmal AF). Extensive ablation, in addition to circumferential pulmonary vein isolation, was more often accomplished in patients with non-paroxysmal AF than in those with paroxysmal AF (87.4% vs. 25.3%, p < 0.001). During a median follow-up of 54 months, sinus rhythm (SR) was maintained in 67.1% after index procedure. After redo procedures in 418 patients, 83.3% exhibited SR maintenance. Recurrence rates were similar for single and multiple procedures (17.4% vs. 16.7%, p = 0.765). Subanalysis showed that the extent of late gadolinium enhancement (LGE), as assessed by cardiac magnetic resonance, is greater in patients with recurrence than in those without recurrence (36.2 ± 23.9% vs. 21.8 ± 13.7%, p < 0.001). Cox-regression analysis revealed that non-paroxysmal AF (hazard ratio (HR) 2.238, 95% confidence interval (CI) 1.905–2.629, p < 0.001), overweight (HR 1.314, 95% CI 1.107–1.559, p = 0.020), left atrium dimension ≥ 45 mm (HR 1.284, 95% CI 1.085–1.518, p = 0.004), AF duration (HR 1.020 per year, 95% CI 1.006–1.034, p = 0.004), and LGE ≥ 25% (HR 1.726, 95% CI 1.330–2.239, p < 0.001) are significantly associated with AF recurrence after catheter ablation. This study showed that repeated catheter ablation improves the clinical outcomes of patients with non-paroxysmal AF, suggesting that AF substrate based on LGE may underpin the mechanism of recurrence after catheter ablation.

Original languageEnglish
Article number3164
Pages (from-to)1-13
Number of pages13
JournalJournal of Clinical Medicine
Issue number10
Publication statusPublished - 2020 Oct

Bibliographical note

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.


  • Atrial fibrillation
  • Catheter ablation
  • Magnetic resonance imaging
  • Substrate

ASJC Scopus subject areas

  • General Medicine


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