The population reported here included 333 patients (213 male; mean age 60.2 ± 13.1 years). Forty patients (30 male; 48 ± 9.7 years) met criteria for lone AF, whereas 293 patients (183 male; 68.8 ± 6.9 years) showed AF with comorbidities.
Noninvasive assessment of preablation structural remodeling
Four patients (10%) in the lone AF group were staged in Utah I and 26 patients (65%) in Utah II. A number of patients with lone AF showed distinctive and extensive structural remodeling, as 9 patients (22.5%) with lone AF were staged in Utah III and 1 patient (2.5%) in Utah IV. Seventeen patients (5.8%) with non–lone AF were staged in Utah I, 187 patients (63.82%) in Utah II, 67 patients (22.87%) in Utah III, and 22 patients (7.51%) in Utah IV (). shows patient examples of lone AF with less (Utah I), mild (Utah II), distinctive (Utah III), and extensive (Utah IV) SRM.
Distribution in Utah I to IV
Utah I to IV in patients with lone AF. Posterior–anterior and anterior–posterior view of enhancement (green pattern) versus normal healthy tissue (blue) before ablation in patients with lone AF. AF = atrial fibrillation.
Clinical outcome after ablation
At a mean follow-up period of 324 ± 234 days after ablation, 27 patients (77.14%) with lone AF remained free of AF recurrence, whereas 170 patients (64.89%) with non–lone AF stayed in stable sinus rhythm (P = .150) (). In detail, the success rate in patients with lone AF and Utah I was 100%, in Utah II 81.82%, in Utah III 62.5%, and in Utah IV 0%, whereas the success rate in patients with non–lone AF and Utah I was 100%, in Utah II 71.26%, in Utah III 63.49%, and in Utah IV 4.55%. Patients who suffered from recurrence showed a higher amount of fibrosis prior to ablation (13.72 ± 7.39 vs. 23.30 ± 14.92; P < .001), independent of AF type.
Recurrence rate for Utah I to IV
Comparison of lone AF and non–lone AF
Persistent AF was significantly higher in patients with non–lone AF (P < .005), whereas paroxysmal AF was significantly higher in patients with lone AF (P < .001). Gender was not a predictor for the type of AF (P = .131). No significant difference was observed between the mean enhancements in the 2 study populations (14.08 ± 8.94 vs. 16.94 ± 11.37; P = .0721). summarizes these results. The distribution of groups Utah I to IV shows no significant differences between patients with lone AF and non–lone AF (). In all patients, the amount of enhancement in the LA was independent from the AF duration (R2 = .05; P = NS). The mean duration of AF was 68.8 ± 119.8 months in patients with lone AF, ranging from 1 month to 720 months. In patients with non–lone AF, the mean duration of AF was 68.42 ± 93.63 months within the range from 1 to 528 months. There was no significant difference between the burden in patients with lone AF and non–lone AF (P = .985). One hundred and thirty-two patients (45.05%) in the non–lone AF group were taking ARBs or ACEIs on presentation. The degree of LA fibrosis was similar in patients taking ARBs or ACEIs when compared with the patients not taking the drug (17.14 ± 11.38 vs. 16.78 ± 11.39; P = .78) in the non–lone AF group.
LA wall enhancement prior to ablation
Distribution in groups Utah I to IV.
The success rate in Utah I to IV was comparable in patients with lone AF and non–lone AF (P = NS). The recurrence rate was significantly correlated to the Utah staging groups for SRM (P < .001) () and showed no difference between patients with lone AF and patients with non–lone AF ().
Recurrence in groups Utah I to IV.
Comparison of recurrence rate in patients with lone AF and non–lone AF. AF = atrial fibrillation.