AF Recurrence After Pulmonary Vein Isolation
AF Recurrence After Pulmonary Vein Isolation
Predictors of Recurrence after AF Ablation. Introduction: The objective of this study was to identify the simple preprocedural parameters of atrial fibrillation (AF) recurrence following single ablation procedure in patients with paroxysmal AF during long-term follow-up period.
Methods and Results: Consecutive 474 patients (61 ± 10 years; 364 males, left atrial (LA) diameter 37.6 ± 5.1 mm) with drug-refractory paroxysmal AF who underwent AF ablation were analyzed. Pulmonary vein antrum isolation (PVAI), cavotricuspid isthmus line creation with bidirectional conduction block, and elimination of all non-PV triggers of AF were performed in all patients. With a mean follow-up of 30 ± 13 months after single procedure, 318 patients (67.1%) were in sinus rhythm without any antiarrhythmic drugs. Multivariate analysis using Cox's proportional hazards model, including the age, gender, duration of AF, body mass index, LA size, left ventricular ejection fraction, and presence of hypertension and structural heart disease as variables, demonstrated that LA size was an independent predictor of AF recurrences after PVAI with a 7.2% increase in the probability for every 1 mm increase in LA diameter (P = 0.0007). When the patients were categorized into 3 groups according to the LA diameter, the patients with moderate (40–50 mm) and severe dilatation (>50 mm) had a 1.30-fold (P = 0.0131) and 2.14-fold (P = 0.0057) increase, respectively, in the probability of recurrent AF as compared with the patients with normal LA diameter (≤40 mm).
Conclusion: In the long-term follow-up period, LA size was the best preprocedural predictor of AF recurrence following single ablation procedure in the patients with paroxysmal AF, even in the patients with a relatively small LA.
Over the last decade, radiofrequency (RF) catheter ablation of atrial fibrillation (AF) has become an important therapy with good procedural success rates. Several ablation techniques have been developed; however, electrical pulmonary vein (PV) isolation is the cornerstone of AF ablation, especially for patients with paroxysmal AF. PV antrum isolation (PVAI) has become a widely accepted strategy as being superior to segmental PV isolation with regard to the success rate. Earlier studies proposed several preprocedural predictors of AF recurrence after the ablation procedure. However, because the AF type (paroxysmal, persistent, and long-standing persistent AF), ablation strategy, patient characteristics, and data analyses were highly heterogeneous in those studies, the results were not consistent. In fact, recent published meta-analysis data demonstrated that nonparoxysmal AF might be the only predictor of AF recurrence compared to paroxysmal AF.
The objective of this study was to identify the clinical and echocardiographic parameters easily obtained prior to the procedure using a Cox's proportional hazards model, which may help to predict recurrence after PVAI, in patients with paroxysmal AF over the long-term follow-up period.
Abstract and Introduction
Abstract
Predictors of Recurrence after AF Ablation. Introduction: The objective of this study was to identify the simple preprocedural parameters of atrial fibrillation (AF) recurrence following single ablation procedure in patients with paroxysmal AF during long-term follow-up period.
Methods and Results: Consecutive 474 patients (61 ± 10 years; 364 males, left atrial (LA) diameter 37.6 ± 5.1 mm) with drug-refractory paroxysmal AF who underwent AF ablation were analyzed. Pulmonary vein antrum isolation (PVAI), cavotricuspid isthmus line creation with bidirectional conduction block, and elimination of all non-PV triggers of AF were performed in all patients. With a mean follow-up of 30 ± 13 months after single procedure, 318 patients (67.1%) were in sinus rhythm without any antiarrhythmic drugs. Multivariate analysis using Cox's proportional hazards model, including the age, gender, duration of AF, body mass index, LA size, left ventricular ejection fraction, and presence of hypertension and structural heart disease as variables, demonstrated that LA size was an independent predictor of AF recurrences after PVAI with a 7.2% increase in the probability for every 1 mm increase in LA diameter (P = 0.0007). When the patients were categorized into 3 groups according to the LA diameter, the patients with moderate (40–50 mm) and severe dilatation (>50 mm) had a 1.30-fold (P = 0.0131) and 2.14-fold (P = 0.0057) increase, respectively, in the probability of recurrent AF as compared with the patients with normal LA diameter (≤40 mm).
Conclusion: In the long-term follow-up period, LA size was the best preprocedural predictor of AF recurrence following single ablation procedure in the patients with paroxysmal AF, even in the patients with a relatively small LA.
Introduction
Over the last decade, radiofrequency (RF) catheter ablation of atrial fibrillation (AF) has become an important therapy with good procedural success rates. Several ablation techniques have been developed; however, electrical pulmonary vein (PV) isolation is the cornerstone of AF ablation, especially for patients with paroxysmal AF. PV antrum isolation (PVAI) has become a widely accepted strategy as being superior to segmental PV isolation with regard to the success rate. Earlier studies proposed several preprocedural predictors of AF recurrence after the ablation procedure. However, because the AF type (paroxysmal, persistent, and long-standing persistent AF), ablation strategy, patient characteristics, and data analyses were highly heterogeneous in those studies, the results were not consistent. In fact, recent published meta-analysis data demonstrated that nonparoxysmal AF might be the only predictor of AF recurrence compared to paroxysmal AF.
The objective of this study was to identify the clinical and echocardiographic parameters easily obtained prior to the procedure using a Cox's proportional hazards model, which may help to predict recurrence after PVAI, in patients with paroxysmal AF over the long-term follow-up period.
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