{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T15:47:00Z","timestamp":1791733620924,"version":"4.3.4"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Purpose<\/jats:title>\n Evidence regarding left atrial (LA) remodeling with pharmacological rhythm control remains limited, particularly in patients with atrial fibrillation (AF) outside heart\u2010failure\u2010specific populations.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single\u2010center retrospective cohort included 156 adults with paroxysmal or persistent AF receiving mutually exclusive pharmacological rate\u2010control (\n n<\/jats:italic>\n = 92) or rhythm\u2010control (\n n<\/jats:italic>\n = 64) therapy who underwent two transthoracic echocardiograms. LA remodeling was assessed using serial echocardiography, and clinical outcomes were evaluated after the second examination.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 74 patients with paired left atrial volume index (LAVI) measurements, LAVI increased from 39.9 to 50.3\u00a0mL\/m\n 2<\/jats:sup>\n with rate control (\n p<\/jats:italic>\n < 0.001) but remained unchanged with rhythm control (44.9 to 43.4\u00a0mL\/m\n 2<\/jats:sup>\n ;\n p<\/jats:italic>\n = 0.465). After adjustment for baseline LAVI and clinical covariates, rhythm control was associated with a 9.38\u00a0mL\/m\n 2<\/jats:sup>\n lower follow\u2010up LAVI (95% CI, \u201015.53 to \u20103.24;\n p<\/jats:italic>\n = 0.003). The association with lower follow\u2010up LAVI was also observed among patients without heart failure and remained similar in sensitivity analyses. During post\u2010landmark follow\u2010up, rhythm control was associated with a lower hazard of all\u2010cause mortality or stroke hospitalization (adjusted HR, 0.46; 95% CI, 0.24\u20130.88;\n p<\/jats:italic>\n = 0.019).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Pharmacological rhythm control was associated with more favorable longitudinal LA remodeling than rate control, including among patients without heart failure, and was also associated with a lower hazard of subsequent all\u2010cause mortality or stroke hospitalization.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/echo.70646","type":"journal-article","created":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T15:40:27Z","timestamp":1791733227000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Left Atrial Remodeling With Pharmacological Rhythm Versus Rate Control in Paroxysmal and Persistent Atrial Fibrillation"],"prefix":"10.1111","volume":"43","author":[{"given":"Shao\u2010Fu","family":"Chien","sequence":"first","affiliation":[{"name":"Cardiovascular Center Cathay General Hospital Taipei Taiwan"},{"name":"School of Public Health College of Public Health Taipei Medical University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih\u2010Hui","family":"Chin","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Cathay General Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao\u2010Chien","family":"Chang","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Cathay General Hospital Taipei Taiwan"},{"name":"School of Medicine College of Medicine Fu Jen Catholic University New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Yu","family":"Huang","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Cathay General Hospital Taipei Taiwan"},{"name":"School of Medicine College of Medicine Fu Jen Catholic University New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung\u2010Yi","family":"Chiou","sequence":"additional","affiliation":[{"name":"School of Public Health College of Public Health Taipei Medical University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio\u2010Thoracic Surgery (EACTS)","volume":"45","author":"Gelder I. C.","year":"2024","journal-title":"European Heart Journal"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Joglar J. A.","year":"2024","journal-title":"Circulation"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1056\/NEJMoa021328","article-title":"A Comparison of Rate Control and Rhythm Control in Patients With Atrial Fibrillation","volume":"347","author":"Wyse D. G.","year":"2002","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1056\/NEJMoa021375","article-title":"A Comparison of Rate Control and Rhythm Control in Patients With Recurrent Persistent Atrial Fibrillation","volume":"347","author":"Gelder I. C.","year":"2002","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early Rhythm\u2010control Therapy in Patients With Atrial Fibrillation","volume":"383","author":"Kirchhof P.","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.ahj.2004.04.029","article-title":"The Association of Left Atrial Size and Occurrence of Atrial Fibrillation: A Prospective Cohort Study From the Canadian Registry of Atrial Fibrillation","volume":"148","author":"Parkash R.","year":"2004","journal-title":"American Heart Journal"},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ijcard.2004.03.010","article-title":"Changes in Left Atrial Size in Patients With Persistent Atrial Fibrillation: A Prospective Echocardiographic Study With a 5\u2010Year Follow\u2010Up Period","volume":"101","author":"Wozakowska\u2010Kaplon B.","year":"2005","journal-title":"International Journal of Cardiology"},{"key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/S0828-282X(07)70841-3","article-title":"Left Atrial Enlargement as a Predictor of Recurrences in Lone Paroxysmal Atrial Fibrillation","volume":"23","author":"Zaca V.","year":"2007","journal-title":"Canadian Journal of Cardiology"},{"key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.hrthm.2004.09.028","article-title":"Effect of Rate and Rhythm Control on Left Ventricular Function and Cardiac Dimensions in Patients With Persistent Atrial Fibrillation: Results From the RAte Control Versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) Study","volume":"2","author":"Hagens V. E.","year":"2005","journal-title":"Heart Rhythm"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1161\/CIRCULATIONAHA.104.484766","article-title":"Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size","volume":"112","author":"Beukema W. P.","year":"2005","journal-title":"Circulation"},{"key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.15171\/jcvtr.2017.08","article-title":"The Significance of the Left Atrial Volume Index in Prediction of Atrial Fibrillation Recurrence After Electrical Cardioversion","volume":"9","author":"Toufan M.","year":"2017","journal-title":"Journal of Cardiovascular and Thoracic Research"},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcha.2024.101364","article-title":"Left Atrial Volume Index: A Predictor of Atrial Fibrillation Recurrence Following Direct Current Cardioversion\u2014A Systematic Review and Meta\u2010Analysis","volume":"51","author":"Raniga D.","year":"2024","journal-title":"IJC Heart & Vasculature"},{"key":"e_1_2_12_14_1","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2023.1265269","article-title":"Effects of Rhythm Control on Left Atrial Structure Remodeling in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction","volume":"10","author":"Bai L.","year":"2023","journal-title":"Frontiers in Cardiovascular Medicine"},{"key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations From the American Society of Echocardiography","volume":"32","author":"Mitchell C.","year":"2019","journal-title":"Journal of the American Society of Echocardiography"},{"key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1056\/NEJMoa2012883","article-title":"Low\u2010Dose Edoxaban in Very Elderly Patients With Atrial Fibrillation","volume":"383","author":"Okumura K.","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"190","DOI":"10.23736\/S2724-5683.23.06446-3","article-title":"Modified Haller Index Is Inversely Associated With Asymptomatic Status in Atrial Fibrillation Patients Undergoing Electrical Cardioversion: A Preliminary Observation","volume":"72","author":"Sonaglioni A.","year":"2024","journal-title":"Minerva Cardiology and Angiology"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70646","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70646","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70646","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T15:40:30Z","timestamp":1791733230000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70646"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/echo.70646"],"URL":"https:\/\/doi.org\/10.1111\/echo.70646","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-09-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70646"}}