European Heart Journal Advance Access originally published online on March 29, 2007
European Heart Journal 2007 28(7):836-841; doi:10.1093/eurheartj/ehm027
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Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation
Arrhythmia Section, Thorax Institute, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
Received 28 April 2006; revised 2 December 2006; accepted 23 February 2007; online publish-ahead-of-print 29 March 2007.
* Corresponding author. Tel: +34 93 227 5551; fax: +34 93 451 3045. E-mail address: lmont{at}clinic.ub.es
Aims: The success rate of circumferential pulmonary vein ablation (CPVA) to treat atrial fibrillation (AF) ranges from 60 to 90%, depending on the series. The objective of the study was to identify predictors of AF recurrence after a standardized CPVA procedure.
Methods and results: A series of 148 consecutive patients undergoing CPVA for symptomatic paroxysmal (60.8%), persistent (23.6%), or permanent (15.5%) AF refractory to antiarrhythmic drugs were included in the study. CPVA with the creation of supplementary block lines along the posterior wall and mitral isthmus was performed and a minimum of 6 months follow-up completed in all patients. Structural heart disease was present in 19.6% and hypertension in 33.8% of patients. After 13.1 ± 8.4 months follow-up, 73.6% of patients were free of AF recurrences after a mean of 1.18 ± 0.45 procedures/patient (one procedure in 85.2%, two procedures in 14.8%, and three procedures in 2.7%). Univariable analysis showed that the risk of AF recurrence increases with age (HR 1.03; 95% CI 1.00–1.06, P = 0.031), with the presence of previous hypertension (HR 2.7; 95% CI 1.43–5.07, P = 0.002), and if AF is permanent (HR 2.23; 95% CI 1.08–4.59, P = 0.042). In addition, larger anteroposterior left atrial diameter (LAD) (HR 1.11; 95% CI 1.05–1.18, P = 0.001) and larger left ventricular end-systolic diameter (HR 1.07; 95% CI 1.00–1.15, P = 0.029) prior to the procedure were associated with AF recurrence after CPVA. Cox regression analysis showed that hypertension (OR = 2.8; 95% CI 1.5–5.4; P = 0.002) and LAD (OR = 1.1; 95% CI 1.05–1.19, P < 0.001) were independent predictors of AF recurrence. The mean predicted proportion of patients with AF recurrence after CPVA of the multivariable model showed a linear relationship with the increase in LAD prior to the procedure. The presence of hypertension further increased the mean predicted proportion of patients with AF recurrence at each LAD.
Conclusion: Hypertension and LAD are independent pre-procedural predictors of AF recurrence after CPVA to treat AF. These data may help in patient selection for AF ablation.
Key Words: Atrial fibrillation • Ablation • Predictors
The first two authors have contributed equally to this work.
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