{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T15:20:40Z","timestamp":1786807240885,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: For many years, catheter ablation (CA) has been a cornerstone in atrial fibrillation (AF) rhythm control therapy; however, recurrence remains common. Multiple parameters have been proposed to quantify AF arrhythmogenic substrate, yet reliable predictors of long-term outcomes are lacking. To assess the value of non-invasive amplified P-wave duration (PWD), echocardiographic parameters, biomarkers, and electroanatomical mapping (EAM) were used in predicting left atrial (LA) fibrosis and arrhythmia recurrence after CA. Methods: We included 196 patients undergoing first CA for paroxysmal or persistent AF. Amplified 12-lead ECG PWD parameters [Pmax, Pmin and left atrial P-wave (LAP)], echocardiographic parameters, and biomarkers were assessed pre-procedure. We measured low-voltage areas (LVA, 0.2\u20130.5 mV) on high-density voltage EAM during sinus rhythm as a surrogate of fibrosis. Freedom from arrhythmia was evaluated at 6 and 12 months. Results: Patients with LVA on EAM had prolonged Pmax (148 vs. 135 ms, p &lt; 0.0001), Pmin (111 vs. 101.5 ms, p = 0.0001), LAP (73.5 vs. 55.5 ms, p &lt; 0.0001), larger LA diameter (p = 0.0002), area (p = 0.0365) and volume (p = 0.004), higher E\/E\u2019 (p = 0.0007) and E\/A ratios (p = 0.037), more mitral regurgitation (p = 0.0315), and higher pro-BNP levels (p = 0.0094). Univariate analysis showed 12-month recurrence rates higher with greater Pmax, Pmin, LAP, LVA presence and extent; however, in multivariate analysis, only P-wave parameters remained independently associated with recurrence. Conclusions: Prolonged PWD parameters strongly reflect LA substrate (Pmax, Pmin) and independently predict post-ablation AF recurrence (Pmax, Pmin, and LAP). LA size, diastolic dysfunction, and mitral regurgitation were associated with LA fibrosis, while pro-BNP was associated with both fibrosis and arrhythmia recurrence. Integrating these simple, non-invasive markers into a multimodal assessment alongside EAM could improve pre-procedural risk stratification and guide individualized ablation strategies.<\/jats:p>","DOI":"10.3390\/jcm14186414","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T14:23:50Z","timestamp":1757600630000},"page":"6414","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multimodal Evaluation of Arrhythmogenic Substrate Predicts Atrial Fibrosis and Atrial Fibrillation Recurrence After Catheter Ablation"],"prefix":"10.3390","volume":"14","author":[{"given":"Ioan-Alexandru","family":"Minciun\u0103","sequence":"first","affiliation":[{"name":"5th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1944-4088","authenticated-orcid":false,"given":"Raluca","family":"Tomoaia","sequence":"additional","affiliation":[{"name":"5th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Vajda","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering and Measurements, Technical University, 400394 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoleta Cosmina","family":"Hart","sequence":"additional","affiliation":[{"name":"5th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Paula","family":"Agoston","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tudor","family":"Cornea","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgiana Alexandra","family":"Birsan","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea-Maria","family":"Linul","sequence":"additional","affiliation":[{"name":"5th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Cismaru","sequence":"additional","affiliation":[{"name":"5th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Puiu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu Ovidiu","family":"Ro\u0219u","sequence":"additional","affiliation":[{"name":"5th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gelu","family":"Simu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1744-7952","authenticated-orcid":false,"given":"Dana","family":"Pop","sequence":"additional","affiliation":[{"name":"5th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"ref_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-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. 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Arrhythm."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6414\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:43:59Z","timestamp":1760035439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":30,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186414"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186414","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,11]]}}}