{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:59:07Z","timestamp":1791219547809,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,9,10]],"date-time":"2013-09-10T00:00:00Z","timestamp":1378771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>AF Ablation in Patients with Large LA<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The effect of catheter ablation on severe left atrial enlargement especially in nonparoxysmal atrial fibrillation (NPAF) patients is not well understood. Whether reverse remodelling may occur after ablation has not been evaluated in this setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Fifty consecutive patients with left atrial diameter (LAD) \u226550\u00a0mm, and LA volume &gt;200 cc undergoing catheter ablation for drug\u2010refractory NPAF were included in this study. Transthoracic echocardiographic measurements were performed at baseline and at 12\u2010months postprocedure. Left ventricular end\u2010diastolic and end\u2010systolic dimensions were indexed by body surface area (LVEDDI, LVESDI). Electroanatomic mapping system (Carto or NavX system) and computed tomography (CT) were used for 3\u2010dimensional reconstruction of the LA. All patients underwent posterior wall isolation and pulmonary vein (PV) antrum and extra PV trigger ablations. Long\u2010term follow\u2010up was monitored by event recordings, 7\u2010day Holter monitors and office visits.<\/jats:p><jats:p>The mean age was 65\u00a0\u00b1\u00a010 years, 78% male, persistent AF 22 (44%), longstanding AF 28 (56%), LAD diameter 56.9 \u00b1 7.8 mm, left ventricular ejection fraction (LVEF) 53 \u00b1 14 and median AF duration 72 (49\u201396) months. At 12\u2010month follow\u2010up, 27 patients (54%) remained arrhythmia\u2010free off antiarrhythmic drugs. Significant reduction in LAD at follow\u2010up (\u226510% reduction) was observed in 52% (26\/50) of the total population and among the 63% (17\/27) of recurrence\u2010free patients. Magnitude of LA reduction was identically distributed among the persistent and longstanding persistent AF cohorts (16 \u00b1 12% vs 14 \u00b1 16%, respectively, P\u00a0= 0.15). A significant 20% improvement in LVEF (from 53 \u00b1 14 to 58 \u00b1 9, P = 0.03) was found in the overall population. Improvement was noted in recurrence\u2010free patients. No significant change in LVEDDI and LVESDI was noted. After adjusting for baseline risk factors in a multivariable model, a reduction in LAD was identified as a strong predictor of long\u2010term success (beta = \u201311.1, P = 0.013). Preexisting LA scarring was associated with increased LAD (beta = 2.7, P = 0.023). No periprocedural or long\u2010term complications were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results show that atrial fibrillation ablation is effective in NPAF patients with severe LA enlargement and is associated with LA reverse remodeling and improvement in LVEF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.12253","type":"journal-article","created":{"date-parts":[[2013,8,2]],"date-time":"2013-08-02T15:45:07Z","timestamp":1375458307000},"page":"1224-1231","source":"Crossref","is-referenced-by-count":43,"title":["Efficacy of Catheter Ablation in Nonparoxysmal Atrial Fibrillation Patients with Severe Enlarged Left Atrium and Its Impact on Left Atrial Structural Remodeling"],"prefix":"10.1111","volume":"24","author":[{"given":"AGNES","family":"PUMP","sequence":"first","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"},{"name":"Heart Institute, Faculty of Medicine University of Pecs  Pecs Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LUIGI","family":"DI BIASE","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"},{"name":"Department of Biomedical Engineering University of Texas  Austin Texas USA"},{"name":"Department of Cardiology University of Foggia  Foggia Italy"},{"name":"Albert Einstein College of Medicine at Montefiore Hospital  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JUSTIN","family":"PRICE","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PRASANT","family":"MOHANTY","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RONG","family":"BAI","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"},{"name":"Department of Cardiology Center of Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PASQUALE","family":"SANTANGELI","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"},{"name":"Department of Cardiology University of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SANGHAMITRA","family":"MOHANTY","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHINTAN","family":"TRIVEDI","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RACHEL (XUE)","family":"YAN","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RODNEY","family":"HORTON","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JAVIER E.","family":"SANCHEZ","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JASON","family":"ZAGRODZKY","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SHANE","family":"BAILEY","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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