{"id":40924,"date":"2025-09-24T15:57:45","date_gmt":"2025-09-24T15:57:45","guid":{"rendered":"https:\/\/www.newsbeep.com\/nz\/40924\/"},"modified":"2025-09-24T15:57:45","modified_gmt":"2025-09-24T15:57:45","slug":"the-risk-factors-of-atrial-substrate-remodeling-in-the-patients-of-paroxysmal-atrial-fibrillation-following-pulmonary-vein-isolation-bmc-cardiovascular-disorders","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/nz\/40924\/","title":{"rendered":"The risk factors of atrial substrate remodeling in the patients of paroxysmal atrial fibrillation following pulmonary vein isolation | BMC Cardiovascular Disorders"},"content":{"rendered":"

Study population<\/p>\n

During a median follow-up period of 4\u00a0years, 102 patients undergoing repeat ablation procedures were enrolled, with exclusion criteria detailed in Fig.\u00a01<\/a>. The cohort was stratified into an atrial substrate remodeling (ASR) group (n\u2009=\u200949, 48%; mean age: 62.0\u2009\u00b1\u20099.0\u00a0years, 45%male) and non-atrial substrate remodeling (NASR) group (n\u2009=\u200953, 52%; mean age: 61.0\u2009\u00b1\u200910.0\u00a0years, 62%male).<\/p>\n

Fig.\u00a01\"figure<\/a><\/p>\n

The protocol and flow of our study<\/p>\n

Baseline characteristics and clinical parameters<\/p>\n

Baseline demographic and clinical characteristics are summarized in Table\u00a01<\/a>. The two groups demonstrated comparable distributions of age, gender, body mass index (BMI), smoke, alcohol, combined diseases (hypertension, T2DM, heart failure, etc.), NT-pro-BNP, and average HAS-BLED score. Similarly, anti-arrhythmia medication profiles were similarly balanced between groups, including \u03b2-blocker use (55% vs. 59%, P\u2009=\u20090.73), amiodarone (57% vs. 74%, P\u2009=\u20090.08), and propafenone (18% vs. 13%, P\u2009=\u20090.47). Notably, the ASR group exhibited a significantly higher CHA2DS2-VASc score compared to the NASR group (2.5\u2009\u00b1\u20091.4 vs. 1.8\u2009\u00b1\u20091.6, P\u2009=\u20090.02) (Fig.\u00a02<\/a>A), suggesting an elevated thromboembolic risk profile.\n<\/p>\n

Table\u00a01 Baseline characteristics of the PaAF population undergoing repeat ablation procedureFig.\u00a02\"figure<\/a><\/p>\n

A Patients in ASR group had significantly higher average CHA2DS2-VASc score than that in NASR group. B PaAF patients with atrial substrate remodeling (ASR group) had longer time interval post 1st CPVI ablation than NASR group (P\u2009<\u20090.001) via violin plot. C The recurrent type of arrhythmia made no significant difference between ASR group and NASR group. PaAF was the most common type of recurrent arrhythmia post 1st ablation procedure. D The distribution of abnormal atrial substrate areas in ASR group. E The distribution of non-pulmonary foci of RA and LA in ASR group. F A representative figure of low voltage area (bipolar voltage\u2009<\u20090.5\u00a0mV, tagged by yellow circle) locating at the LA posterior wall on CARTO system. ASR\u2009=\u2009Atrial Substrate Remodeling; NASR\u2009=\u2009No Atrial Substrate Remodeling; PaAF\u2009=\u2009paroxysmal atrial fibrillation; PsAF\u2009=\u2009persistent atrial fibrillation; AT\u2009=\u2009Atrial tachycardia; LA\u2009=\u2009Left atrium; CTI\u2009=\u2009Cavo tricuspid isthmus; RA\u2009=\u2009Right atrium; LAA\u2009=\u2009Left atrial appendage; SVC\u2009=\u2009Superior vena cava; RAA\u2009=\u2009Right atrial appendage. P value\u2009<\u20090.05 means significant difference by arterisk<\/p>\n

Recurrence patterns post-ablation<\/p>\n

The median time to arrhythmia recurrence following the initial ablation was significantly prolonged in the ASR group (6\u00a0years vs. 3\u00a0years;\u00a0P\u2009<\u20090.05; Fig.\u00a02<\/a>B) compared to the NASR group, indicating a distinct delayed recurrence phenotype in ASR patients after catheter ablation (CA).<\/p>\n

PVs-LA reconnection between ASR and NASR group<\/p>\n

During repeat ablation procedures, PVs-LA reconnection was systematically analyzed. In the NASR group, 92 PVs-LA reconnection were identified, with 32 patients (60% of the NASR cohort) exhibiting PV recurrence. The recurrence distribution across individual PVs was as follows: right superior PV (RSPV, 16.3%; 15\/92), right inferior PV (RIPV, 21.7%; 20\/92), left superior PV (LSPV, 38.0%; 35\/92) and left inferior PV (LIPV, 23.9%; 22\/92)respectively, with LSPV demonstrating the highest recurrence frequency.<\/p>\n

In contrast, the ASR group exhibited significantly fewer PVs-LA reconnections compared to the NASR group (16 vs. 92 reconnections, P\u2009<\u20090.001). The recurrence rates for individual PVs in the ASR cohort were RSPV (18.8%; 3\/16), RIPV (25.0%; 4\/16), LSPV(37.5%; 6\/16) and LIPV(18.8%; 3\/16), with LSPV remaining the most recurrent PV. Notably, no statistically significant differences were observed in the recurrence rates of individual PVs between the ASR and NASR group (P\u2009>\u20090.05 for all comparisons).<\/p>\n

Recurrent arrhythmia profiles<\/p>\n

Recurrent arrhythmias during follow-up were classified into four subtypes: paroxysmal atrial fibrillation (PaAF), persistent atrial fibrillation (PsAF), atrial tachycardia (AT), and combined AF\/AT. The ASR group exhibited a significantly higher incidence of PsAF recurrence compared to the NASR group (20% [10\/49] vs. 4% [2\/53];\u00a0P\u2009<\u20090.05). Conversely, the NASR group demonstrated a higher predominance of PaAF recurrence (79% [42\/53] vs. 33% [16\/49] in the ASR group;\u00a0P\u2009<\u20090.05). No significant intergroup difference was observed in isolated AT recurrence. However, a higher proportion of ASR patients experienced combined AF\/AT recurrence compared to the NASR group(24% [12\/49] vs. 9% [5\/53];\u00a0P\u2009<\u20090.05; Fig.\u00a02<\/a>C).<\/p>\n

Area distribution of ASR<\/p>\n

In the ASR cohort (n\u2009=\u200965), all newly identified low-voltage areas (LVAs) were localized to the LA (Fig.\u00a02<\/a>F) with no RA involvement. The LA anterior wall demonstrated the highest prevalence of structural remodeling (38.5%, 25\/65), followed by the posterior (21.5%, 14\/65) and inferior walls (21.5%, 14\/65), lateral wall (13.8%, 9\/65), and interatrial septum (4.6%,3\/65), as depicted in Fig.\u00a02<\/a>D.<\/p>\n

Non-PV foci were identified in 33 cases, with predominant RA distribution (66.7%, 22\/33 vs. 33.3%, 11\/33 in LA). RA foci clustered at the cavo tricuspid isthmus (CTI, 72.7%, 16\/22), with sparse distribution at the right atrial appendage (RAA, 4.5%,1\/22), superior vena cava (SVC, 9.1%,2\/22), crista terminalis (4.5%,1\/22), and RA septum (4.5%,1\/22). LA foci primarily localized to the mitral isthmus (63.6%, 7\/11), with additional sites at the roof (18.2%, 2\/11), left atrial appendage( LAA,9.1%,1\/11), and LA septum (9.1%,1\/11), as showed in Fig.\u00a02<\/a>E.<\/p>\n

Cardiac function comparison between ASR and NASR cohorts<\/p>\n

No intergroup difference was observed in baseline NT-proBNP levels (P\u2009>\u20090.05), left atrium size (LA1: 38.6\u2009\u00b1\u20095.3\u00a0mm vs. 38.5\u2009\u00b1\u20094.4\u00a0mm, P\u2009=\u20090.86), and left ventricular ejection fraction (LVEF1: 65.3\u2009\u00b1\u20096.9% vs. 65.3\u2009\u00b1\u20094.4%, P\u2009=\u20090.95). Furthermore, at the repeat procedure, no significant difference was found in LA size (LA2: 39.9\u2009\u00b1\u20096.0\u00a0mm vs. 38.1\u2009\u00b1\u20094.4\u00a0mm, P\u2009=\u20090.11) and LVEF (LVEF2: 64.0\u2009\u00b1\u20095.1% vs. 65.6\u2009\u00b1\u20094.2%, P\u2009=\u20090.10). Longitudinal analysis revealed no significant changes in LA (\u25b3LA\u2009=\u2009LA2-LA1: 0.4(-3.7,6.5) mm vs. -0.9(-5.6,3.7) mm, P\u2009=\u20090.32) and LVEF (\u25b3LVEF\u2009=\u2009LVEF2-LVEF1: -0.1(-4.2,3.1)% vs. 0(-3,3.6)%, P\u2009=\u20090.50) between the ASR and NASR groups, suggesting that ASR did not impact the changes in LA size or LVEF (Table 2<\/a>).\n<\/p>\n

Table\u00a02 Type of recurrent arrhythmia and cardiac structure between ASR group and NASR groupPredictors of ASR in the VLR of PaAF population<\/p>\n

The clinical factors associated with ASR are summarized in Table\u00a03<\/a>. Cox regression analysis identified recurrent persistent AF (PsAF) as an independent predictor of ASR development: univariate association: HR\u2009=\u20096.54, 95% CI 1.35\u201331.57, P\u2009=\u20090.02, Multivariate adjustment (HR\u2009=\u20092.66, 95%CI\u2009=\u20091.05\u20136.73, P\u2009=\u20090.04). (adjusted for age, CHA2DS2-VASc score, and atrial dilatation status).\n<\/p>\n

Table\u00a03 Risk factors associated with ASR in the VLR of PaAF population<\/p>\n","protected":false},"excerpt":{"rendered":"Study population During a median follow-up period of 4\u00a0years, 102 patients undergoing repeat ablation procedures were enrolled, with…\n","protected":false},"author":2,"featured_media":40925,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[18204,36935,36940,36939,3533,36936,36938,2294,134,3536,14214,111,139,69,36934,36937],"class_list":["post-40924","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-angiology","tag-atrial-substrate","tag-blood-transfusion-medicine","tag-cardiac-surgery","tag-cardiology","tag-catheter-ablation","tag-cha2ds2-vasc-score","tag-general","tag-health","tag-internal-medicine","tag-medicine-public-health","tag-new-zealand","tag-newzealand","tag-nz","tag-paroxysmal-atrial-fibrillation","tag-recurrence"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/40924","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=40924"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/40924\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/40925"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=40924"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=40924"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=40924"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}