title: Long-Term Clinical Results of 2 Different Ablation Strategies in Patients With Paroxysmal and Persistent Atrial Fibrillation Improved endothelial function in patients with atrial fibrillation through maintenance of sinus rhythm by successful catheter ablation. The difference in autonomic denervation and its effect on atrial fibrillation recurrence between the standard segmental and circumferential pulmonary vein isolation techniques. The effects of statins and renin-angiotensin system blockers on atrial fibrillation recurrence following antral pulmonary vein isolation. Detection and Quantification of Left Atrial Structural Remodeling With Delayed-Enhancement Magnetic Resonance Imaging in Patients With Atrial Fibrillation Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: The A4 Study Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation Circumferential pulmonary-vein ablation for chronic atrial fibrillation. Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial† Predictive value of early recurrence and delayed cure after catheter ablation for patients with chronic atrial fibrillation. Obstructive sleep apnoea risk profile and the risk of recurrence of atrial fibrillation after catheter ablation. The impact of statins and renin-angiotensin-aldosterone system blockers on pulmonary vein antrum isolation outcomes in post-menopausal females. Safety and efficacy of catheter ablation of atrial fibrillation in patients with diabetes mellitus—single center experience
abstract: Background — Data regarding the long-term efficacy of atrial fibrillation ( AF ) ablation are still lacking . Methods and Results —Two hundred four consecutive patients symptomatic for paroxysmal or persistent/permanent AF were r and omly assigned to 2 different ablation schemes : pulmonary vein isolation ( PVI ) and PVI plus left linear lesions ( LL ) . Primary end point was to assess the maintenance of sinus rhythm ( SR ) after procedures 1 and 2 in the absence of antiarrhythmic drugs in a long-term follow-up of at least 3 years . Paroxysmal AF — With a single procedure at 12-month follow-up , 46 % of patients treated with PVI maintained SR , whereas at 3-year follow-up , 29 % were in SR ; using the “ PVI plus LL ” at the 12-month follow-up , 57 % of patients were in SR , whereas at the 3-year follow-up , 53 % remained in SR . After a second procedure , the long-term overall success rate without antiarrhythmic drugs was 62 % with PVI and 85 % with PVI plus LL . Persistent/Permanent AF — With a single procedure at the 12-month follow-up , 27 % of patients treated with PVI were in SR , whereas at the 3-year follow-up , 19 % maintained SR ; using the PVI plus LL with a single procedure at the 12-month follow-up 45 % of patients were in SR , whereas at the 3-year follow-up , 41 % remained in SR . After a second procedure , the long-term overall success rate without antiarrhythmic drugs was 39 % with PVI and 75 % with PVI plus LL . Conclusions —A long-term follow-up of AF ablation shows that short-term results can not be considered permanent because AF recurrences are still present after the first year especially in patients who have had “ PVI ” strategy .  PVI isolation plus LL is superior to the PVI strategy in maintaining SR without antiarrhythmic drugs after procedures 1 and 2 both in paroxysmal and persistent AF BACKGROUND Although atrial fibrillation ( AF ) is a risk factor for endothelial dysfunction ( ED ) , the effect of catheter ablation ( CA ) on AF-associated ED has not been evaluated . The aims of this study are to determine if the degree of ED predicts the outcome of AF ablation and to evaluate whether ED can be improved through restoring sinus rhythm ( SR ) by successful CA . METHODS This study prospect ively enrolled 80 subjects who underwent CA for AF ( paroxysmal AF = 61 , persistent AF = 19 ) . Eighty subjects with no history of AF were enrolled as controls , all of whom were matched by age , gender , body mass index , and atherosclerotic risk factor distribution . Brachial artery flow-mediated dilatation ( FMD ) was measured at baseline , and at 1 month and 6 months post CA in AF subjects who remained in SR . Among controls , FMD was measured at baseline and at 6 months . We used high sensitivity C-reactive protein ( hs-CRP ) , interleukin-6 , soluble E- or P-selectin , and endothelin-1 as biomarker indices for inflammation and /or ED . RESULTS Compared with controls , AF subjects had lower FMD at baseline ( FMD(baseline ) , P < 0.001 ) . After successful CA , FMD was significantly improved at 1 month and 6 months , nearly approaching control levels . A multivariate analysis revealed that FMD(baseline ) , hs-CRP , and left atrial volume ( LAV ) were independent predictors for arrhythmia recurrence after CA . Other biomarkers were not related to rhythm outcome . CONCLUSION AF subjects have significantly impaired FMD , which can be reversed through maintenance of SR by successful CA . FMD(baseline ) , hs-CRP , and LAV are important predictors for AF recurrence after CA AIMS This study examined the difference in autonomic modification ( AM ) and its effect on paroxysmal atrial fibrillation ( PAF ) recurrence between segmental pulmonary vein isolation ( S-PVI ) and circumferential PVI ( C-PVI ) . METHODS AND RESULTS Successful S-PVI or C-PVI with a basket catheter was achieved in 120 consecutive PAF patients . Serial 24 Holter-recordings were obtained before , immediately , and 1 , 3 , 6 , 12 months after the PVI to analyse the heart rate variability ( HRV ) .  Nineteen patients were excluded from analysis because of additional ablation for recurrent PAF after successful PVI . Among the residual 101 patients , 33 had PAF recurrences ( S-PVI = 44.0 % , C-PVI = 21.6 % ) at 1 year of follow-up . The root mean square of successive differences and high-frequency power reflecting parasympathetic nervous activity were significantly lower in patients with and without PAF recurrences after C-PVI and patients without PAF recurrences after S-PVI than patients with PAF recurrences after S-PVI ( P < 0.005 - 0.0001 ) . However , there were no significant differences in any HRV parameters in the immediate aftermath of PVI among the patients without PAF recurrences after S-PVI and those with and without PAF recurrences after C-PVI . CONCLUSION Although additional radiofrequency ablation for AM may be recommended after S-PVI to reduce PAF recurrences , it should be carefully determined after C-PVI INTRODUCTION Ablation has emerged as a major treatment option for atrial fibrillation ( AF ) . However , this procedure is limited by a significant rate of AF recurrence . We aim ed to examine the effects of statins , angiotensin-converting enzyme inhibitors ( ACE-I ) , and angiotensin receptor blockers ( ARB ) on the recurrence rate of AF following ablation . METHODS We conducted a retrospective study of 177 consecutive patients ( mean age = 56 + /- 11 yrs , 69 % males ) who underwent ablation for paroxysmal ( n = 132 ) or persistent AF ( n = 45 ) . Patients were treated with ACE-I ( n = 31 ) or ARB ( n = 18 ) or statins ( n = 50 ) prior to ablation and for the duration of follow-up . RESULTS After a mean follow-up of 13.8 + /- 8.6 months , 72 % of patients were free of AF . For patients taking statins , 33 of 50 ( 60 % ) were free of AF . In patients treated with ACE-I , 17 of 31 ( 55 % ) were free from AF , while in the group of patients treated with ARB , 17 of 18 ( 94 % ) were free from AF . Using Cox regression analysis to correct for baseline variables , treatment with statins did not decrease the recurrence rate ( HR = 1.10 [ 95 % CI : 0.55 - 2.27 ] p = 0.79 ) ; nor did treatment with renin angiotensin system ( RAS ) blockers ( HR 0.94 [ 95 % CI : 0.46 - 1.93 ] p = 0.87 ) . However , subgroup analysis showed that treatment with ARB was associated with a trend towards lower AF recurrence [ HR 0.17 , ( 95 % CI : 0.02 - 1.34 ) p = 0.09 ] . CONCLUSIONS Even though statins and RAS blockers possess anti-inflammatory properties , they did not decrease the recurrence of AF following ablation . However , the subset of patients taking ARB exhibited a trend towards lower AF recurrence . Larger , r and omized studies are needed to address this observation Background — Atrial fibrillation ( AF ) is associated with diffuse left atrial fibrosis and a reduction in endocardial voltage . These changes are indicators of AF severity and appear to be predictors of treatment outcome . In this study , we report the utility of delayed-enhancement magnetic resonance imaging ( DE-MRI ) in detecting abnormal atrial tissue before radiofrequency ablation and in predicting procedural outcome . Methods and Results — Eighty-one patients presenting for pulmonary vein antrum isolation for treatment of AF underwent  3-dimensional DE-MRI of the left atrium before the ablation .  Six healthy volunteers also were scanned . DE-MRI images were manually segmented to isolate the left atrium , and custom software was implemented to quantify the spatial extent of delayed enhancement , which was then compared with the regions of low voltage from electroanatomic maps from the pulmonary vein antrum isolation procedure . Patients were assessed for AF recurrence at least 6 months after pulmonary vein antrum isolation , with an average follow-up of 9.6±3.7 months ( range , 6 to 19 months ) . On the basis of the extent of preablation enhancement , 43 patients were classified as having minimal enhancement ( average enhancement , 8.0±4.2 % ) , 30 as having moderate enhancement ( 21.3±5.8 % ) , and 8 as having extensive enhancement ( 50.1±15.4 % ) . The rate of AF recurrence was 6 patients ( 14.0 % ) with minimal enhancement , 13 ( 43.3 % ) with moderate enhancement , and 6 ( 75 % ) with extensive enhancement ( P<0.001 ) . Conclusions — DE-MRI provides a noninvasive means of assessing left atrial myocardial tissue in patients suffering from AF and might provide insight into the progress of the disease . Preablation DE-MRI holds promise for predicting responders to AF ablation and may provide a metric of overall disease progression Background — The mainstay of treatment for atrial fibrillation ( AF ) remains pharmacological ; however , catheter ablation has increasingly been used over the last decade . The relative merits of each strategy have not been extensively studied . Methods and Results — We conducted a r and omized multicenter comparison of these 2 treatment strategies in patients with paroxysmal AF resistant to at least 1 antiarrhythmic drug . The primary end point was absence of recurrent AF between months 3 and 12 , absence of recurrent AF after up to 3 ablation procedures , or changes in antiarrhythmic drugs during the first 3 months . Ablation consisted of pulmonary vein isolation in all cases , whereas additional extrapulmonary vein lesions were at the discretion of the physician . Crossover was permitted at 3 months in case of failure . Echocardiographic data , symptom score , exercise capacity , quality of life , and AF burden were evaluated at 3 , 6 , and 12 months by the supervising committee . Of 149 eligible patients , 112 ( 18 women [ 16 % ] ; age , 51.1±11.1 years ) were enrolled and r and omized to ablation ( n=53 ) or “ new ” antiarrhythmic drugs alone or in combination ( n=59 ) . Crossover from the antiarrhythmic drugs and ablation groups occurred in 37 ( 63 % ) and 5 patients ( 9 % ) , respectively ( P=0.0001 ) . At the 1-year follow-up , 13 of 55 patients ( 23 % ) and 46 of 52 patients ( 89 % ) had no recurrence of AF in the antiarrhythmic drug and ablation groups , respectively ( P<0.0001 ) . Symptom score , exercise capacity , and quality of life were significantly higher in the ablation group . Conclusion — This r and omized multicenter study demonstrates the superiority of catheter ablation over antiarrhythmic drugs in patients with AF with regard to maintenance of sinus rhythm and improvement in symptoms , exercise capacity , and quality of life OBJECTIVES The purpose of this study was to evaluate the associations of transthoracic echocardiographic parameters with recurrent atrial fibrillation ( AF ) and /or stroke . BACKGROUND The Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study , an evaluation of elderly patients with AF at risk for stroke , provided an opportunity to evaluate the implication s of echocardiographic parameters in patients with AF . METHODS  Transthoracic echocardiographic measures of mitral regurgitation ( MR ) , left atrial ( LA ) diameter , and left ventricular ( LV ) function were evaluated in the AFFIRM rate- and rhythm-control patients who had sinus rhythm resume and had these data available .  Risk for recurrent AF or stroke was evaluated with respect to transthoracic echocardiographic measures . RESULTS Of 2,474 patients studied , 457 had > or = 2(+)/4(+ ) MR , and 726 had a LA diameter > 4.5 cm . The  LV ejection fraction was abnormal in 543 patients . The cumulative probabilities of at least one AF recurrence/stroke were 46%/1 % after 1 year and 84%/5 % by the end of the trial ( > 5 years ) , respectively . Multivariate analysis showed that r and omization to the rhythm-control arm ( hazard ratio [ HR ] = 0.64 ; p < 0.0001 ) and a qualifying episode of AF being the first known episode ( HR = 0.70 ; p < 0.0001 ) were associated with decreased risk . Duration of qualifying AF episode > 48 h ( HR = 1.55 ; p < 0.0001 ) and LA diameter ( p = 0.008 ) were associated with an increased risk of recurrent AF . Recurrent AF was more likely with larger LA diameters ( HR = 1.21 , 1.16 , and 1.32 for mild , moderate , and severe enlargement , respectively ) . No transthoracic echocardiographic measures were associated with risk of stroke . CONCLUSIONS In the AFFIRM study , large transthoracic echocardiographic LA diameters were associated with recurrent AF , but no measured echocardiographic parameter was associated with stroke Aims The objective of the study was to analyse the influence of left ventricular ( LV ) ejection fraction ( EF ) on the outcomes of  atrial fibrillation ( AF ) ablation after a first procedure . Pre-procedural predictors of recurrences after AF ablation can be useful for patient information and selection of c and i date s. The independent influence of LV systolic dysfunction on recurrence rate has not been studied . Methods and results A case – control study ( 1:1 ) was conducted with a total of 72 patients : 36 cases ( depressed LVEF ) and 36 controls ( normal LVEF ) . Patients were matched by left atrial diameter ( LAD ) , the presence of arterial hypertension , and other variables that might influence the results ( age , gender and paroxysmal vs. persistent AF ) . There were no statistical differences in the variables used to perform the matching . Patients with depressed LVEF had higher LV end diastolic diameter ( 55.6 ± 6.2 vs. 52.4 ± 5.5 , P = 0.03 ) , higher LV end systolic diameter ( 40.3 ± 6.9 vs. 32.6 ± 4.3 , P < 0.001 ) , lower LVEF ( 41.4 ± 8.0 vs. 63.1 ± 5.5 , P < 0.001 ) and were more likely to have structural heart disease . After a mean follow-up of 16 ± 13 months , survival analysis for AF recurrences showed no differences between patients with depressed vs. normal LVEF ( 50.0 vs. 55.6 % , log rank = 0.82 ) . Cox regression analysis revealed LAD to be the only variable correlated to recurrence [ OR 1.11 ( 1.01–1.22 ) , P = 0.03 ] . Analysis at 6 months showed a significant increase in LVEF ( 43.23 ± 7.61 to 51.12 ± 13.53 % , P = 0.01 ) for the case group . Conclusion LV systolic dysfunction by itself is not a predictor of outcome after AF ablation . LAD independently correlates with outcome in patients with low or normal LVEF BACKGROUND We conducted a r and omized , controlled trial of circumferential pulmonary-vein ablation for the treatment of chronic atrial fibrillation . METHODS A total of 146 patients with a mean ( + /-SD ) age of 57+/-9 years who had chronic atrial fibrillation were r and omly assigned to receive amiodarone and undergo two cardioversions during the first three months alone ( the control group ) or in combination with circumferential pulmonary-vein ablation . Cardiac rhythm was assessed with daily telephonic transmissions for one year . The left atrial diameter and the severity of symptoms were assessed at 12 months . RESULTS Among the 77 patients assigned to undergo circumferential pulmonary-vein ablation , ablation was repeated because of recurrent atrial fibrillation in 26 percent of patients and atypical atrial flutter in 6 percent . An intention-to-treat analysis showed that 74 percent of patients in the ablation group and 58 percent of those in the control group were free of recurrent atrial fibrillation or flutter without antiarrhythmic-drug therapy at one year ( P=0.05 ) . Among the 69 patients in the control group , 53 ( 77 percent ) crossed over to undergo circumferential pulmonary-vein ablation for recurrent atrial fibrillation by one year and only 3 ( 4 percent ) were in sinus rhythm without antiarrhythmic-drug therapy or ablation . There were significant decreases in the left atrial diameter ( 12+/-11 percent , P<0.001 ) and the symptom severity score ( 59+/-21 percent , P<0.001 ) among patients who remained in sinus rhythm after circumferential pulmonary-vein ablation . Except for atypical atrial flutter , there were no complications attributable to circumferential pulmonary-vein ablation . CONCLUSIONS Sinus rhythm can be maintained long term in the majority of patients with chronic atrial fibrillation by means of circumferential pulmonary-vein ablation independently of the effects of antiarrhythmic-drug therapy , cardioversion , or both . The maintenance of sinus rhythm is associated with a significant decrease in both the severity of symptoms and the left atrial diameter Aims This multicentre , r and omized trial compared three strategies of AF ablation : ablation of complex fractionated electrograms ( CFE ) alone , pulmonary vein isolation ( PVI ) alone , and combined PVI + CFE ablation , using st and ardized automated mapping software . Methods and results Patients with drug-refractory , high-burden paroxysmal ( episodes > 6 h , > 4 in 6 months ) or persistent atrial fibrillation ( AF ) were enrolled at eight centres . Patients ( n = 100 ) were r and omized to one of three arms . For CFE alone ( n = 34 ) , spontaneous/induced AF was mapped using vali date d , automated CFE software and all sites < 120 ms were ablated until AF termination/non-inducibility . For PVI ( n = 32 ) , all four PV antra were isolated and confirmed using a circular catheter . For PVI + CFE ( n = 34 ) , all four PV antra were isolated , followed by AF induction and ablation of all CFE sites until AF termination/non-inducibility . Patients were followed at 3 , 6 , and 12 months with a visit , ECG , 48 h Holter . Atrial fibrillation symptoms were confirmed by loop recording . Repeat procedures were allowed within the first 6 months . The primary endpoint was freedom from AF > 30 s at 1 year . Patients ( age 57 ± 10 years , LA size 42 ± 6 mm ) were 35 % persistent AF . In CFE , ablation terminated AF in 68 % . Only 0.4 PVs per patient were isolated as a result of CFE . In PVI , 94 % had all four PVs successfully isolated . In PVI + CFE , 94 % had all four PVs isolated , 76 % had inducible AF with additional CFE ablation , with 73 % termination of AF . There were significantly more repeat procedures in the CFE arm ( 47 % ) vs. PVI ( 31 % ) or PVI + CFE ( 15 % ) ( P = 0.01 ) . After one procedure , PVI + CFE had a significantly higher freedom from AF ( 74 % ) compared with PVI ( 48 % ) and CFE ( 29 % ) ( P = 0.004 ) . After two procedures , PVI + CFE still had the highest success ( 88 % ) compared with PVI ( 68 % ) and CFE ( 38 % ) ( P = 0.001 ) . Ninety-six percent of these patients were off anti-arrhythmics . Complications were two tamponades , no PV stenosis , and no mortality . Conclusion In high-burden paroxysmal/persistent AF , PVI + CFE has the highest freedom from AF vs. PVI or CFE alone after one or two procedures . Complex fractionated electrogram alone has the lowest one and two procedure success rates with a higher incidence of repeat procedures . Clinical Trials.gov identifier number NCT00367757 BACKGROUND Radiofrequency catheter ablation ( RFCA ) for curing atrial fibrillation ( AF ) is often followed by early recurrence and delayed cure , so the present study investigate the predictive factors this in patients with chronic AF . METHODS AND RESULTS Ninety-two consecutive patients ( 70 males ; mean age , 58.7+/-6.4 years ) with chronic AF who underwent RFCA for treatment of symptomatic AF were enrolled .  Early recurrence of AF ( ERAF ) occurred in 45 patients after ablation . Not achieving AF termination could predict ERAF ( odds ratio ( OR ) 0.95 ; 95 % confidence interval ( CI ) 0.84 - 1.13 ; p=0.02 ) in multivariate analysis . During a follow-up of 12+/-11 ( range , 5 - 25 ) months , delayed cure occurred in 35.6 % ( 16/45 ) of the patients with ERAF . Left atrial size and AF termination during ablation were related to delayed cure . AF termination was the only independent predictive factor for delayed cure ( OR 1.47 ; 95 % CI 1.05 - 1.87 ; p=0.02 ) . CONCLUSION Not achieving AF termination is the only independent predictor of ERAF . Among patients with ERAF , those with a smaller left atrium and AF termination have a higher probability of delayed cure . AF termination can independently predict delayed cure . These results emphasize the importance of AF termination during ablation for patients with chronic AF AIMS The aim of this study was to identify the impact of obstructive sleep apnoea ( OSA ) on recurrence after catheter ablation of paroxysmal atrial fibrillation ( AF ) . METHODS AND RESULTS One hundred and seventy-eight consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein ( PV ) isolation were prospect ively enrolled . The patients were divided into high risk ( HR group ) and low risk ( LR group ) for OSA group with Berlin question naire . Of the 178 patients , 104 ( 58.4 % ) were in the HR group and 74 ( 41.6 % ) were in the LR group . After a mean follow-up of 344 + /- 137 ( 91 - 572 ) days , 44 patients ( 24.7 % ) experienced recurrence , and the recurrence rate did not differ between the HR ( 25.0 % ) and LR groups ( 24.3 % , P = 0.855 ) . Cox analysis revealed that PV isolation was the only independent predictor of recurrence ( hazard ratio 5.11 , 95 % confidence interval 1.42 - 18.47 , P = 0.013 ) . There was no significant difference in the incidence of complications between the HR and LR groups ( 2.9 vs. 1.9 % , P = 0.729 ) . CONCLUSION The recurrence rate and incidence of complications did not differ in patients with different risk profiles for OSA . The presence of OSA should not lower the decision threshold to choose an ablative procedure in paroxysmal AF AIMS To assess whether treatment with statins or renin-angiotensin-aldosterone system ( RAAS ) inhibitors as potential procedural ' augmenting agents ' improved  atrial fibrillation ( AF )  catheter ablation recurrence rates in post-menopausal females ( PMFS ) . METHODS AND RESULTS Five hundred and eighteen consecutive female patients had undergone AF catheter ablation from January 2005 to May 2008 . Post-menopausal females were selected and procedure outcomes were compared between cohorts of PMFS treated with statins or RAAS inhibitors to untreated PMFS . Out of 408 PMFS , 36 ( 8.8 % ) were treated with a combination of RAAS inhibitors and statins , thus were excluded leaving a total of 372 ( 91.2 % ) patients in the study . Out of 372 patients , 111 ( 29.8 % ) were on statins ( Group 1 ) , 59 ( 15.9 % ) on RAAS inhibitors ( Group 2 ) , and 202 ( 54.3 % ) without RAAS inhibitors or statins [ ( Group 3 ) control population ] . Over a mean follow-up time of 24 + /- 8.3 ( median 25 ) months , 78 ( 70.6 % ) in Group 1 , 38 ( 65.4 % ) in Group 2 , and 139 ( 68.8 % ) in Group 3 had procedural success . Statin or RAAS inhibitor use did not predict lower recurrence rates [ hazard ratio ( HR ) : 1.26 , P = 0.282 and HR : 1.14 , P = 0.728 , respectively ] . When compared with controls , no difference in the cumulative incidence of recurrence was found with statin or RAAS inhibitors use ( P = 0.385 and P = 0.761 , respectively ) . CONCLUSION Treatment with statins or RAAS inhibitors did not improve catheter ablation success rates among PMFS . Thereby , from a clinical st and point , PMFS should not be started on these treatments as a procedural ' augmenting agent ' at this time Background and objective Little is known about the outcome of  catheter ablation of  atrial fibrillation ( AF )  in patients with diabetes mellitus ( DM ) . We investigated the safety and efficacy of catheter ablation of AF  in patients with DM . Material s and methods Thirty one patients with DM from a group of 263 consecutive patients undergoing a first-time catheter ablation of AF procedure  were enrolled in a prospect i ve study . The ablation protocol ( guided by CARTO system ) consisted in two continuous circular lesions around ipsilateral pulmonary veins . Results The following clinical characteristics differed between DM and no-DM patients : age ( 62.0 ± 10.8 vs. 56.1 ± 10.6 years , P = 0.004 ) , longer AF history ( 9.6 ± 9.3 vs. 6.7 ± 6.3 years , P = 0.024 ) , significantly larger left atrium size ( 41.1 ± 7.8 vs. 38.3 ± 5.8 mm , P = 0.021 ) , hypertension ( 58.1 vs. 35.8 % , P = 0.018 ) and structural heart disease ( 67.7 vs. 43.5 % , P = 0.011 ) . Despite a similar AF recurrence rate in DM and no-DM patients ( 32.3 vs. 22.4 % , P = 0.240 ) , the ablation procedure was complicated in 28 patients ( 11 hematomas , three cardiac tamponades and three strokes ) and the incidence of complications was significantly higher in DM than in no-DM patients ( 29.0 vs. 8.2 % , respectively , P = 0.002 ) . Multivariate analysis showed that DM was an independent risk factor for complications occurrence ( odd ratio 5.936 , 95 % confidence interval 2.059 to 17.112 , P = 0.001 ) . Conclusions First catheter ablation of AF procedure in DM patients was equally efficacious than in no-DM patients . However , DM patients had a higher incidence of complications , mostly thrombotic or hemorrhagic
target: Dilated LA significantly increases the risk of AF recurrence after  single CPVI .
  This is especially applicable to the patients with long-term follow-up
background: AIMS Left atrial ( LA ) enlargement is associated with atrial fibrillation ( AF ) .
  However , it is controversial whether dilated atrium can predict post-ablation AF recurrence .
  We undertook a systematic review and meta- analysis to analyse the association between LA diameter and  AF recurrence after single circumferential pulmonary vein isolation ( CPVI )  and explore the potential mechanism .