European Heart Journal Advance Access published online on March 29, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm027
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.
* 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.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Arya, G. Hindricks, P. Sommer, Y. Huo, A. Bollmann, T. Gaspar, K. Bode, D. Husser, H. Kottkamp, and C. Piorkowski Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients Europace, November 3, 2009; (2009) eup331v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. De Potter, A. Berruezo, L. Mont, M. Matiello, D. Tamborero, C. Santibanez, B. Benito, N. Zamorano, and J. Brugada Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation Europace, October 31, 2009; (2009) eup309v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. den Uijl and J. J. Bax Left atrial size as a predictor of successful radiofrequency catheter ablation for atrial fibrillation Europace, October 1, 2009; 11(10): 1255 - 1256. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Matsuo, N. Lellouche, M. Wright, M. Bevilacqua, S. Knecht, I. Nault, K.-T. Lim, L. Arantes, M. D. O'Neill, P. G. Platonov, et al. Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 788 - 795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Terasawa, E. M. Balk, M. Chung, A. C. Garlitski, A. A. Alsheikh-Ali, J. Lau, and S. Ip Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Ann Intern Med, August 4, 2009; 151(3): 191 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Peters, J. V. Wylie, T. H. Hauser, R. Nezafat, Y. Han, J. J. Woo, J. Taclas, K. V. Kissinger, B. Goddu, M. E. Josephson, et al. Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement a pilot study. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 308 - 316. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Tamborero, L. Mont, A. Berruezo, M. Matiello, B. Benito, M. Sitges, B. Vidal, T. M. de Caralt, R. J. Perea, R. Vatasescu, et al. Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective Randomized Study Circ Arrhythm Electrophysiol, February 1, 2009; 2(1): 35 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. P. Letsas, R. Weber, G. Burkle, C. C. Mihas, J. Minners, D. Kalusche, and T. Arentz Pre-ablative predictors of atrial fibrillation recurrence following pulmonary vein isolation: the potential role of inflammation Europace, February 1, 2009; 11(2): 158 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Muller, S. Noble, P.-F. Keller, P. Sigaud, P. Gentil, R. Lerch, D. Shah, and H. Burri Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography Europace, September 1, 2008; 10(9): 1073 - 1078. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Matiello, L. Mont, D. Tamborero, A. Berruezo, B. Benito, E. Gonzalez, and J. Brugada Cooled-tip vs. 8 mm-tip catheter for circumferential pulmonary vein ablation: comparison of efficacy, safety, and lesion extension Europace, August 1, 2008; 10(8): 955 - 960. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Tan, M. Rienstra, A. C.P. Wiesfeld, B. A. Schoonderwoerd, H. H.F. Hobbel, and I. C. Van Gelder Long-term outcome of the atrioventricular node ablation and pacemaker implantation for symptomatic refractory atrial fibrillation Europace, April 1, 2008; 10(4): 412 - 418. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Arriagada, A. Berruezo, L. Mont, D. Tamborero, I. Molina, B. Coll-Vinent, B. Vidal, M. Sitges, P. Berne, J. Brugada, et al. Predictors of arrhythmia recurrence in patients with lone atrial fibrillation Europace, January 1, 2008; 10(1): 9 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. G. Cosio, E. Aliot, G. L. Botto, H. Heidbuchel, C. J. Geller, P. Kirchhof, J.-C. De Haro, R. Frank, J. P. Villacastin, J. Vijgen, et al. Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode Europace, January 1, 2008; 10(1): 21 - 27. [Abstract] [Full Text] [PDF]
|
|