{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T04:08:44Z","timestamp":1768709324060,"version":"3.49.0"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T00:00:00Z","timestamp":1726012800000},"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>Atrial wall thickness (AWT) is a significant factor in understanding the pathological physiological substrate of atrial fibrillation, with a potentially substantial impact on the outcomes of catheter ablation procedures. Precise measurements of the AWT may provide valuable insights for categorising patients with AF and planning targeted interventions. Objectives: The purpose of this study was to evaluate the characteristics of the left atrium (LA) using non-invasive multidetector computed tomography (MDCT) scans and subsequent three-dimensional (3D) image post-processing using novel software designed to calculate atrial thickness dimensions and mass. Methods: We retrospectively analysed 128 consecutive patients (33.6% females; mean age 55.6 \u00b1 11.2 years) referred for AF ablation (37 with persistent AF and 91 with paroxysmal AF) who underwent preprocedural MDCT. The images were post-processed and analysed using the ADAS software (Galgo Medical), automatically calculating the LA volume and regional wall thickness. In addition, the software employed a regional semi-automatic LA parcellation feature that divided the atrial wall into 12 segments, generating atrial wall thickness (AWT) maps per segment for each patient. Results: This study demonstrated considerable variability in the average thickness of LA walls, with the anterior segments being the thickest across the cohort. Distinct sex-specific differences were observed, with males exhibiting greater anterior and septal wall thickness than females. No significant associations were identified between the average AWT and body mass index, LA volume, or sphericity. Survival analysis conducted over 24 months revealed a meaningful relationship between mean anterior wall thickness and recurrence-free survival, with increased thickness associated with a lower likelihood of AF-free survival. No such relationship was observed for the indexed LA volume. Conclusions: The variability in AWT and its association with recurrence-free survival following AF ablation suggest that AWT should be considered when stratifying patients for AF management and ablation strategies. These findings underscore the need for personalised treatment approaches and further research on the interplay of the structural properties of the left atrium as factors that can serve as important prognostic markers in AF treatment.<\/jats:p>","DOI":"10.3390\/jcm13185379","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T05:45:12Z","timestamp":1726033512000},"page":"5379","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Left Atrial Wall Thickness Estimated by Cardiac CT: Implications for Catheter Ablation of Atrial Fibrillation"],"prefix":"10.3390","volume":"13","author":[{"given":"Pedro","family":"Silva Cunha","sequence":"first","affiliation":[{"name":"Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal"},{"name":"Instituto de Fisiologia, Faculdade de Medicina, University of Lisbon, 1649-004 Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2169-4024","authenticated-orcid":false,"given":"S\u00e9rgio","family":"Laranjo","sequence":"additional","affiliation":[{"name":"Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal"},{"name":"Departamento de Fisiologia, NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, NMS, FCM, Universidade NOVA de Lisboa, 1099-085 Lisbon, Portugal"}]},{"given":"Sofia","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal"},{"name":"Instituto de Telecomunica\u00e7\u00f5es, Instituto Superior T\u00e9cnico, 3810-193 Aveiro, Portugal"}]},{"given":"In\u00eas Gr\u00e1cio","family":"Almeida","sequence":"additional","affiliation":[{"name":"Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal"},{"name":"Imagiology Department, Hospital Santa Marta, 1169-024 Lisbon, Portugal"}]},{"given":"Tiago","family":"Mendon\u00e7a","sequence":"additional","affiliation":[{"name":"Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal"},{"name":"Imagiology Department, Hospital Santa Marta, 1169-024 Lisbon, Portugal"}]},{"given":"Il\u00e1dia","family":"Fontes","sequence":"additional","affiliation":[{"name":"Imagiology Department, Hospital Santa Marta, 1169-024 Lisbon, Portugal"}]},{"given":"Rui Cruz","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal"}]},{"given":"Ana G.","family":"Almeida","sequence":"additional","affiliation":[{"name":"CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal"}]},{"given":"Maxim","family":"Didenko","sequence":"additional","affiliation":[{"name":"Heart and Diabetes Center NRW, University Clinic of the Ruhr University Bochum, 44789 Bochum, Germany"}]},{"given":"M\u00e1rio Martins","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal"},{"name":"Instituto de Fisiologia, Faculdade de Medicina, University of Lisbon, 1649-004 Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal"},{"name":"CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Li, H., Song, X., Liang, Y., Bai, X., Liu-Huo, W.-S., Tang, C., Chen, W., and Zhao, L. (2022). Global, regional, and national burden of disease study of atrial fibrillation\/flutter, 1990\u20132019: Results from a global burden of disease study, 2019. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-14403-2"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1016\/j.jacc.2014.02.555","article-title":"Atrial Remodeling and Atrial Fibrillation: Recent advances and translational perspectives","volume":"63","author":"Nattel","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e15053","DOI":"10.14814\/phy2.15053","article-title":"Left atrial conduit function: A short review","volume":"9","author":"Marino","year":"2021","journal-title":"Physiol. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1111\/j.1540-8167.2012.02341.x","article-title":"Fibrotic Atrial Cardiomyopathy: A Specific Disease\/Syndrome Supplying Substrates for Atrial Fibrillation, Atrial Tachycardia, Sinus Node Disease, AV Node Disease, and Thromboembolic Complications","volume":"23","author":"Kottkamp","year":"2012","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1016\/j.jacc.2011.05.061","article-title":"Structural Abnormalities in Atrial Walls Are Associated with Presence and Persistency of Atrial Fibrillation but Not with Age","volume":"58","author":"Platonov","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"098","DOI":"10.23937\/2378-2951\/1410098","article-title":"Left Atrial Wall Thickness and Pulmonary Vein Size are Increased in Patients with Atrial Fibrillation Compared to Healthy Controls\u2014A Multidetector Computed Tomography Study","volume":"4","author":"Thomsen","year":"2017","journal-title":"Int. J. Clin. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jacc.2012.04.032","article-title":"Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study","volume":"60","author":"Santangeli","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.hrthm.2010.06.030","article-title":"Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayed-enhanced MRI: Implications for disease progression and response to catheter ablation","volume":"7","author":"Mahnkopf","year":"2010","journal-title":"Hearth Rhythm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1002\/joa3.12512","article-title":"Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals","volume":"37","author":"Rebecchi","year":"2021","journal-title":"J. Arrhythmia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S0008-6363(02)00273-0","article-title":"Structural correlate of atrial fibrillation in human patients","volume":"54","author":"Kostin","year":"2002","journal-title":"Cardiovasc. Res."},{"key":"ref_11","first-page":"1758","article-title":"The role of myocardial wall thickness in atrial arrhythmogenesis","volume":"18","author":"Whitaker","year":"2016","journal-title":"Europace"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1001\/jama.2014.3","article-title":"Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation","volume":"311","author":"Marrouche","year":"2014","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.jcmg.2018.11.037","article-title":"The Future of Cardiovascular Computed Tomography","volume":"12","author":"Nicol","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/j.1540-8167.2006.00549.x","article-title":"Morphologic Characteristics of the Left Atrial Appendage, Roof, and Septum: Implications for the Ablation of Atrial Fibrillation","volume":"17","author":"Wongcharoen","year":"2006","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1093\/eurheartj\/ehm606","article-title":"The architecture of the left lateral atrial wall: A particular anatomic region with implications for ablation of atrial fibrillation","volume":"29","author":"Cabrera","year":"2008","journal-title":"Eur. Hearth J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101138","DOI":"10.1016\/j.ijcha.2022.101138","article-title":"The atrial fibrillation burden during the blanking period is predictive of time to recurrence after catheter ablation","volume":"43","author":"Cunha","year":"2022","journal-title":"IJC Hearth Vasc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jacep.2017.06.023","article-title":"Evaluation of a Strategy Aiming to Enclose the Pulmonary Veins with Contiguous and Optimized Radiofrequency Lesions in Paroxysmal Atrial Fibrillation","volume":"4","author":"Taghji","year":"2018","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"186","DOI":"10.15420\/aer2017.26.1","article-title":"Ganglionated Plexi Ablation: Physiology and Clinical Applications","volume":"6","author":"Stavrakis","year":"2017","journal-title":"Arrhythmia Electrophysiol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/europace\/eux013","article-title":"Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: A meta-analysis","volume":"20","author":"Njoku","year":"2018","journal-title":"Europace"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1161\/CIRCEP.109.924985","article-title":"Association of Left Atrial Endothelin-1 With Atrial Rhythm, Size, and Fibrosis in Patients with Structural Heart Disease","volume":"3","author":"Mayyas","year":"2010","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1161\/01.CIR.89.2.724","article-title":"Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study","volume":"89","author":"Vaziri","year":"1994","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/europace\/eup198","article-title":"Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation","volume":"11","author":"Abecasis","year":"2009","journal-title":"Europace"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.jacc.2011.09.076","article-title":"Histopathologic Characterization of Chronic Radiofrequency Ablation Lesions for Pulmonary Vein Isolation","volume":"59","author":"Kowalski","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1161\/CIRCULATIONAHA.104.533190","article-title":"Response of Atrial Fibrillation to Pulmonary Vein Antrum Isolation Is Directly Related to Resumption and Delay of Pulmonary Vein Conduction","volume":"112","author":"Verma","year":"2005","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100574","DOI":"10.1016\/j.ijcha.2020.100574","article-title":"Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation","volume":"29","author":"Mulder","year":"2020","journal-title":"IJC Hearth Vasc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s42444-021-00046-8","article-title":"Left atrial wall thickness and its relationship with reconnection after pulmonary vein isolation in patients with atrial fibrillation evaluated using a three-dimensional wall thickness map","volume":"22","author":"Oh","year":"2021","journal-title":"Int. J. Arrhythmia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1161\/CIRCEP.113.000050","article-title":"Rearrangement of Atrial Bundle Architecture and Consequent Changes in Anisotropy of Conduction Constitute the 3-Dimensional Substrate for Atrial Fibrillation","volume":"6","author":"Maesen","year":"2013","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1161\/CIRCEP.111.962720","article-title":"Left Atrial Anatomy Revisited","volume":"5","author":"Ho","year":"2012","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e004133","DOI":"10.1161\/CIRCEP.116.004133","article-title":"Myofiber Architecture of the Human Atria as Revealed by Submillimeter Diffusion Tensor Imaging","volume":"9","author":"Pashakhanloo","year":"2016","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/jce.16092","article-title":"Characteristics of tissue temperature during ablation with THERMOCOOL SMARTTOUCH SF versus TactiCath versus QDOT MICRO catheters (Qmode and Qmode+): An in vivo porcine study","volume":"35","author":"Otsuka","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_31","first-page":"1200","article-title":"Direct Epicardial Validation of Posterior Wall Electroporation in Persistent Atrial Fibrillation","volume":"10","author":"Solimene","year":"2024","journal-title":"JACC: Clin. Electrophysiol."},{"key":"ref_32","first-page":"390","article-title":"Personalized paroxysmal atrial fibrillation ablation by tailoring ablation index to the left atrial wall thickness: The \u2018Ablate by-LAW\u2019 single-centre study\u2014A pilot study","volume":"24","author":"Teres","year":"2021","journal-title":"EP Eur."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/18\/5379\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:53:45Z","timestamp":1760111625000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/18\/5379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,11]]},"references-count":32,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["jcm13185379"],"URL":"https:\/\/doi.org\/10.3390\/jcm13185379","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,11]]}}}