ABC | Volume 112, Nº5, May 2019

Short Editorial Wu Left atrial stiffness and atrial fibrillation Arq Bras Cardiol. 2019; 112(5):509-510 1. Ha AC, Wijeysundera HC, Birnie DH, Verma A. Real-world outcomes, complications, and cost of catheter-based ablation for atrial fibrillation: an update. Curr Opin Cardiol. 2017;32(1):47-52. 2. Calkins H, Hindricks G, Cappato R, KimYH, Saad EB, Aguinaga, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECEexpertconsensusstatementoncatheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1–e160. 3. Bunch TJ, May HT, Bair TL, Jacobs V, Crandall BG, Cutler M, et al. The impact of age on 5-year outcomes after atrial fibrillation catheter ablation. J Cardiovasc Electrophysiol. 2016 Feb;27:141-6. 4. Teunissen C, Kassenberg W, van der Heijden JF, Hassink RJ, Vincent JHM, NidcesPA.Five-yearefficacyofpulmonaryveinantrum isolationasaprimary ablation strategy for atrial fibrillation: a single-centre cohort study. Europace. 2016;18(9):1335-42. 5. Thomas L, Abhayaratna WP. Left atrial reverse remodeling. mechanisms, evaluation, and clinical significance. JACC Cardiovascular Imaging. 2017;10(1):65-77. 6. Leite-Moreira AF, Oliveira SM, Marino P. Left atrial stiffness and its implications for cardiac function. Future Cardiol. 2007; 3(2):175–183 7. Gibson DN, Di Biase L, Mohanti P, Patel JD, Bai R, Sanchez J, et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: clinical characterization, prevalence, and predictors. Heart Rhythm. 2011;8(9):1364-71 8. Njoku A, Kannabhiran M, Arora R, Reddy P, Gopinathannair R, Lakkireddy D, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace. 2018;20(1):33–42. 9. Ma XX, Boldt LH, Zhang YL, Zhu MR, Hu B, Parwani A, et al. Clinical relevance of left atrial strain to predict recurrence of atrial fibrillation after catheter ablation: ameta-analysis. Echocardiography. 2016;33(5):724–33. 10. Correia ETO, Barbetta LMS, Silva OMP, Mesquita ET. Left atrial stiffness: a predictor of atrial fibrillation recurrence after radiofrequency catheter ablation - a systematic review and meta-analysis. Arq Bras Cardiol. 2019; 112(5):501-508 References This is an open-access article distributed under the terms of the Creative Commons Attribution License indication recommendations are weaker and only limited to patients with paroxysmal AF. These recommendations usually lead physicians to treat patients with CA after a longer history period of clinical AF. The development of tools and methods to determine markers of atrial cardiomyopathy may allow to avoid the mismatch of the best time for CA, in accordance with more substrate and patient-oriented process of diagnosis and therapy of AF. Certainly, further studies will be required to support identification by noninvasive cardiac imaging of patients for whom CA should be considered early before there is significant LA functional remodeling with associated fibrosis. 510