ArticleHeart rhythm O22026
Preprocedural cardiac computed tomography assessment of left atrial posterior wall morphology predicts atrial tachyarrhythmia recurrence after cryoballoon pulmonary vein isolation.
Article in Heart rhythm O2, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF), yet its long-term efficacy remains limited. The left atrial posterior wall (LAPW) has emerged as an important arrhythmogenic substrate associated with recurrence after PVI. Objective: The purpose of this study was to determine whether LAPW morphology, quantified by preprocedural cardiac computed tomography angiography (CCTA), is associated with atrial tachyarrhythmia (ATA) recurrence after cryoballoon PVI (CB-PVI). Methods: We retrospectively analyzed 252 consecutive patients with AF (paroxysmal AF, n = 184 [73.0%]) undergoing first-time CB-PVI. LAPW morphology on CCTA was quantified as the left atrial roof line length, left atrial bottom line length, LAPW circumference (LAPC), and LAPW area. The primary end point was Results: During a median follow-up of 70 months (interquartile range 44.5-88.0 months), ATA recurred in 63 patients (25.0%). Patients with recurrence had larger LAPW dimensions. In multivariable Cox analysis, LAPC was significantly associated with recurrence (hazard ratio 1.079 per mm; 95% confidence interval 1.047-1.111 per mm; Conclusion: Preprocedural enlargement of the LAPW, particularly an increased LAPC, was significantly associated with ATA recurrence after CB-PVI. Quantitative assessment of LAPW morphology using routine preprocedural CCTA provides prognostic information that may complement conventional clinical and echocardiographic measures for recurrence risk stratification and individualized ablation strategies.
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