Lau, Dennis H.Middeldorp, Melissa E.Brooks, Anthony G.Ganesan, Anand N.Roberts-Thomson, Kurt C.Stiles, Martin K.Leong, Darryl P.Abed, Hany S.Lim, Han S.Wong, Christopher X.Willoughby, Scott R.Young, Glenn D.Kalman, Jonathan M.Abhayaratna, WalterSanders, Prashanthan2015-10-062015-10-061932-6203http://hdl.handle.net/1885/15780BACKGROUND Recent community-based research has linked aortic stiffness to the development of atrial fibrillation. We posit that aortic stiffness contributes to adverse atrial remodeling leading to the persistence of atrial fibrillation following catheter ablation in lone atrial fibrillation patients, despite the absence of apparent structural heart disease. Here, we aim to evaluate aortic stiffness in lone atrial fibrillation patients and determine its association with arrhythmia recurrence following radio-frequency catheter ablation. METHODS We studied 68 consecutive lone atrial fibrillation patients who underwent catheter ablation procedure for atrial fibrillation and 50 healthy age- and sex-matched community controls. We performed radial artery applanation tonometry to obtain central measures of aortic stiffness: pulse pressure, augmentation pressure and augmentation index. Following ablation, arrhythmia recurrence was monitored at months 3, 6, 9, 12 and 6 monthly thereafter. RESULTS Compared to healthy controls, lone atrial fibrillation patients had significantly elevated peripheral pulse pressure, central pulse pressure, augmentation pressure and larger left atrial dimensions (all P<0.05). During a mean follow-up of 2.9±1.4 years, 38 of the 68 lone atrial fibrillation patients had atrial fibrillation recurrence after initial catheter ablation procedure. Neither blood pressure nor aortic stiffness indices differed between patients with and without atrial fibrillation recurrence. However, patients with highest levels (≥75(th) percentile) of peripheral pulse pressure, central pulse pressure and augmentation pressure had higher atrial fibrillation recurrence rates (all P<0.05). Only central aortic stiffness indices were associated with lower survival free from atrial fibrillation using Kaplan-Meier analysis. CONCLUSION Aortic stiffness is an important risk factor in patients with lone atrial fibrillation and contributes to higher atrial fibrillation recurrence following catheter ablation procedure.Drs. Lau and Leong are supported by a Postdoctoral Fellowship from the National Health and Medical Research Council of Australia (NHMRC). Drs. Brooks, Roberts-Thomson and Sanders are supported by the Heart Foundation of Australia (HFA). Dr. Ganesan is supported by a CVL grant from Pfizer Australia. Dr. Abed is supported by an Australian Postgraduate Award and an Earl Bakken Fellowship from the University of Adelaide. Dr. Lim is supported by a Postgraduate Scholarship from NHMRC. Dr. Wong is supported by the Rhodes scholarship. Dr. Willoughby is supported by the NHMRC. This work is supported by an equipment grant from Tom Simpson Trust Fund, HFA.© 2013 Lau et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.agedaortaarterial pressureatrial fibrillationcase-control studiescatheter ablationfemalefollow-up studieshumansmalemiddle agedrecurrencerisk factorssurvival analysistime factorstreatment outcomevascular stiffness2013-10-0310.1371/journal.pone.00767762016-06-14