English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

mapping during ablation, which could influence the ablation approach and often defines the prognosis of arrhythmia recurrence. Pathophysiological AF results in electrical and structural remodeling (inflammation, fibrosis, and atrial dilatation). LVA represent atrial remodeling processes and are considered to play an important role in AF progression.3 LVA can be found in 10% of patients with paroxysmal AF and in 35% of patients with persistent AF. However, by performing individually tailored substrate modification, a significantly higher arrhythmia-free survival rate compared with the conventional approach can be achieved.8 Furthermore, the reliable documentation of rhythm outcomes is not possible using 2 days’ Holter monitoring, as the most of asymptomatic arrhythmia episodes, which occur frequently after ablation, cannot be adequately detected. Therefore, continuous ECG monitoring is preferred when analyzing the prediction of rhythm outcomes. Finally, the group with a very small LA was small compared with the other groups in this study, which could impair the statistical analysis and its interpretation. Furthermore, the patients in this group were young, had mostly paroxysmal AF (>90%) and low rates of cardiovascular comorbidities. All this does not really ‘fit’ with our understanding of AF progression and does not explain worse rhythm outcomes. In our opinion, this might be related to the poor access and manipulation during catheter ablation in a small atria. It would be interesting to see how single-shot devices such as the cryo-balloon would have performed in this patient group. Although not explicitly mentioned in the manuscript, probably a double-transseptal approach was used with simultaneous LA access by 2 long sheaths; this could in particular affect the results because in very small atria this technique is rather demanding in terms of manual skills. In summary, the role of LA size remains an interesting topic with regard to predicting LVA and rhythm outcomes. However, because AF is a multifaceted disorder including polymorphic mechanisms during its development and perpetuation, a meaningful combination of different variables (imaging, biomarkers, patients’ clinical profile) could be helpful in shaping individualized AF management and predicting rhythm outcomes.

Left Atrial Size and the Risk for Recurrence After Catheter Ablation: Is a Small Left Atrial as Bad as a Large One?