Skip to main content
SpringerLink
Log in

The impact of height on recurrence after index catheter ablation of paroxysmal atrial fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The relationship between height and incident atrial fibrillation (AF) has recently been demonstrated. We aimed to evaluate the impact of height on outcomes of ablation in patients with drug-refractory symptomatic paroxysmal AF (PAF).

Methods

A total of 689 patients (470 males; age, 53.0 ± 11.7 years) with symptomatic paroxysmal AF receiving index catheter ablation (CA) between 2003 and 2013 were enrolled in this study. The baseline characteristics, ablation, and follow-up results were evaluated. The patients were categorized according to the quartiles of height for each sex.

Results

Patients in the lower quartiles of height had a lower incidence of AF recurrence (log-rank p = 0.022). Height in female patients was strongly associated with AF recurrence (p = 0.027) after an index ablation in the 6.33 ± 4.32 years of follow-up. Female patients > 159 cm in height had a higher likelihood of AF recurrence after index CA (HR = 2.01, 95% CI: 1.24–3.25, p = 0.005) than that in those below this height. In computed tomography (CT) scan, the superoinferior diameter of the left atrium (LA) correlated with body height in females, but not in male patients.

Conclusions

Height is associated with AF recurrence after the index CA of PAF in female patients. In Asian populations, women above height 159 cm are twice as likely to have AF recurrence post-ablation as shorter women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Available upon request.

Code availability

Available upon request.

References

  1. Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol. 2011;57(2):160–6. https://doi.org/10.1016/j.jacc.2010.05.061.

    Article  PubMed  Google Scholar 

  2. Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation. 2010;122(23):2368–77. https://doi.org/10.1161/CIRCULATIONAHA.110.946806.

    Article  PubMed  Google Scholar 

  3. Chao TF, Tsao HM, Lin YJ, Tsai CF, Lin WS, Chang SL, et al. Clinical outcome of catheter ablation in patients with nonparoxysmal atrial fibrillation: results of 3-year follow-up. Circ Arrhythm Electrophysiol. 2012;5(3):514–20. https://doi.org/10.1161/CIRCEP.111.968032.

    Article  PubMed  Google Scholar 

  4. Chang HY, Lo LW, Lin YJ, Chang SL, Hu YF, Li CH, et al. Long-term outcome of catheter ablation in patients with atrial fibrillation originating from nonpulmonary vein ectopy. J Cardiovasc Electrophysiol. 2013;24(3):250–8. https://doi.org/10.1111/jce.12036.

    Article  PubMed  Google Scholar 

  5. Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005;111(2):127–35. https://doi.org/10.1161/01.CIR.0000151289.73085.36.

    Article  PubMed  Google Scholar 

  6. Lo LW, Tai CT, Lin YJ, Chang SL, Wongcharoen W, Hsieh MH, et al. Characteristics and outcome in patients receiving multiple (more than two) catheter ablation procedures for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19(2):150–6. https://doi.org/10.1111/j.1540-8167.2007.01012.x.

    Article  PubMed  Google Scholar 

  7. Andersen K, Rasmussen F, Neovius M, Tynelius P, Sundström J. Body size and risk of atrial fibrillation: a cohort study of 1.1 million young men. J Intern Med. 2018;283(4):346–55. https://doi.org/10.1111/joim.12717.

    Article  CAS  PubMed  Google Scholar 

  8. Schmidt M, Botker HE, Pedersen L, Sorensen HT. Adult height and risk of ischemic heart disease, atrial fibrillation, stroke, venous thromboembolism, and premature death: a population based 36-year follow-up study. Eur J Epidemiol. 2014;29(2):111–8. https://doi.org/10.1007/s10654-013-9867-y.

    Article  PubMed  Google Scholar 

  9. Marott JL, Skielboe AK, Dixen U, Friberg JB, Schnohr P, Jensen GB. Increasing population height and risk of incident atrial fibrillation: the Copenhagen City Heart Study. Eur Heart J. 2018;39(45):4012–9. https://doi.org/10.1093/eurheartj/ehy367.

    Article  PubMed  Google Scholar 

  10. Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH. Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 1999;10(11):1525–33. https://doi.org/10.1111/j.1540-8167.1999.tb00211.x.

    Article  CAS  PubMed  Google Scholar 

  11. Tsao HM, Wu MH, Huang BH, Lee SH, Lee KT, Tai CT, et al. Morphologic remodeling of pulmonary veins and left atrium after catheter ablation of atrial fibrillation: insight from long-term follow-up of three-dimensional magnetic resonance imaging. J Cardiovasc Electrophysiol. 2005;16(1):7–12. https://doi.org/10.1046/j.1540-8167.2005.04407.x.

    Article  PubMed  Google Scholar 

  12. Lo LW, Chiou CW, Lin YJ, Chang SL, Hu YF, Tsao HM, et al. Differences in the atrial electrophysiological properties between vagal and sympathetic types of atrial fibrillation. J Cardiovasc Electrophysiol. 2013;24(6):609–16. https://doi.org/10.1111/jce.12098.

    Article  PubMed  Google Scholar 

  13. Cronin P, Saab A, Kelly AM, Gross BH, Patel S, Kazerooni EA, et al. Measurements of pulmonary vein ostial diameter and distance to first bifurcation: a comparison of different measurement methods. Eur J Radiol. 2009;71(1):61–8. https://doi.org/10.1016/j.ejrad.2008.04.008.

    Article  PubMed  Google Scholar 

  14. Chang SL, Tai CT, Lin YJ, Wongcharoen W, Lo LW, Tuan TC, et al. The efficacy of inducibility and circumferential ablation with pulmonary vein isolation in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18(6):607–11. https://doi.org/10.1111/j.1540-8167.2007.00823.x.

    Article  PubMed  Google Scholar 

  15. Lo LW, Lin YJ, Chang SL, Hu YF, Chao TF, Chung FP, et al. Predictors and characteristics of multiple (more than 2) catheter ablation procedures for atrial fibrillation. J Cardiovasc Electrophysiol. 2015;26(10):1048–56. https://doi.org/10.1111/jce.12748.

    Article  PubMed  Google Scholar 

  16. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1–160. https://doi.org/10.1093/europace/eux274.

    Article  PubMed  Google Scholar 

  17. Chen WT, Chang SL, Lin YJ, Lo LW, Hu YF, Chao TF, et al. The impact of anatomical remodeling of the left atrium and pulmonary vein on the recurrence of paroxysmal atrial fibrillation after catheter ablation. Int J Cardiol. 2014;176(3):1173–5. https://doi.org/10.1016/j.ijcard.2014.07.250.

    Article  PubMed  Google Scholar 

  18. Akoum N, Mahnkopf C, Kholmovski EG, Brachmann J, Marrouche NF. Age and sex differences in atrial fibrosis among patients with atrial fibrillation. Europace. 2018;20(7):1086–92. https://doi.org/10.1093/europace/eux260.

    Article  PubMed  Google Scholar 

  19. Gillis AM. Atrial fibrillation and ventricular arrhythmias: sex differences in electrophysiology, epidemiology, clinical presentation, and clinical outcomes. Circulation. 2017;135(6):593–608. https://doi.org/10.1161/CIRCULATIONAHA.116.025312.

    Article  PubMed  Google Scholar 

  20. Rosenberg MA, Patton KK, Sotoodehnia N, Karas MG, Kizer JR, Zimetbaum PJ, et al. The impact of height on the risk of atrial fibrillation: the Cardiovascular Health Study. Eur Heart J. 2012;33(21):2709–17. https://doi.org/10.1093/eurheartj/ehs301.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. Framingham Heart Study Circ. 1994;89(2):724–30. https://doi.org/10.1161/01.cir.89.2.724.

    Article  CAS  Google Scholar 

  22. Kosiuk J, Dinov B, Kornej J, Acou WJ, Schonbauer R, Fiedler L, et al. Prospective, multicenter validation of a clinical risk score for left atrial arrhythmogenic substrate based on voltage analysis: DR-FLASH score. Heart Rhythm. 2015;12(11):2207–12. https://doi.org/10.1016/j.hrthm.2015.07.003.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the clinical staff in Taipei Veterans General Hospital for their support.

Funding

The present work was supported by the Taipei Veterans General Hospital (V108C-073, V108-031, V109C-001, V109C-005, V110C-024, V110-014) and Ministry of Science and Technology (MOST108-2314-B-010–051-MY3, MOST108-2811-B-010–542, MOST109-2811-B-010–529, MOST109-2314-B-075A-011-MY3).

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Ching-Han Liu

  2. Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 11217, Taiwan

    Ching-Han Liu, Li-Wei Lo, Fa-Po Chung, Shih-Lin Chang, Yu-Feng Hu, Yenn-Jiang Lin, Shih-Chung Huang, Chin-Yu Lin, Tze-Fan Chao, Jo-Nan Liao, Ta-Chuan Tuan, Chih-Min Liu, Yang-Che Shiu, Cheng-I Wu, Ling Kuo, Jennifer Jeanne B. Vicera, Isaiah Lugtu & Shih-Ann Chen

  3. Division of Cardiology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan

    Ching-Han Liu & Shih-Chung Huang

  4. Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Li-Wei Lo, Fa-Po Chung, Shih-Lin Chang, Yu-Feng Hu, Yenn-Jiang Lin, Chin-Yu Lin, Tze-Fan Chao, Jo-Nan Liao, Ta-Chuan Tuan, Chih-Min Liu, Yang-Che Shiu, Cheng-I Wu, Ling Kuo, Jennifer Jeanne B. Vicera, Isaiah Lugtu, Cheng-Hung Li, Yu-Cheng Hsieh & Shih-Ann Chen

  5. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Su-Ting Gan

  6. Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan

    Cheng-Hung Li, Yu-Cheng Hsieh & Shih-Ann Chen

  7. Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Yi-Jen Chen

  8. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yi-Jen Chen

Authors
  1. Ching-Han Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li-Wei Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fa-Po Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shih-Lin Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu-Feng Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yenn-Jiang Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shih-Chung Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Su-Ting Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chin-Yu Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tze-Fan Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jo-Nan Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ta-Chuan Tuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Chih-Min Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yang-Che Shiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Cheng-I Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Ling Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Jennifer Jeanne B. Vicera
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Isaiah Lugtu
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Cheng-Hung Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Yu-Cheng Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Yi-Jen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Shih-Ann Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CH Liu, FP Chung, LW Lo, and SA Chen initiated the study ideation. CH Liu and LW Lo acquired the data and prepared the manuscript. CH Liu, ST Gan, and SC Huang performed data analysis. LW Lo and SA Chen directed the project. All authors contributed to the study conception and design. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Li-Wei Lo.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board of Taipei Veterans General Hospital (IRB-TPEVGH no. 2019–07-033AC).

Consent to participate

All patients provided their informed consent to the ablation procedure and the anonymized analysis of their personal data.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 35 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, CH., Lo, LW., Chung, FP. et al. The impact of height on recurrence after index catheter ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 64, 587–595 (2022). https://doi.org/10.1007/s10840-021-01055-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-021-01055-2

Keywords

Search

Navigation