Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Endowed Associate Professor
|Article types||Original article|
|Peer review||Peer reviewed|
|Title||Long-term outcome and preprocedural predictors of atrial tachyarrhythmia recurrence following pulmonary vein antrum isolation-based catheter ablation in patients with non-paroxysmal atrial fibrillation.|
|Journal||Formal name：Journal of Cardiology|
|Domestic / Foregin||Domestic|
|Volume, Issue, Page||64(1),pp.57-63|
|Author and coauthor||EJIMA Koichiro†*, ARAI Kotaro, SUZUKI Tsuyoshi, KATO Ken, YOSHIDA Kentaro, NUKI Toshiaki, SUZUKI Futoshi, UEMATSU Shoko, GOMITA Keiko, HOSHI Hiromi, MANAKA Tetsuyuki, ASHIHARA Kyomi, SHODA Morio, HAGIWARA Nobuhisa|
|Authorship||Lead author,Corresponding author|
Although various empiric adjunctive ablation techniques are widely performed with pulmonary vein antrum isolation (PVAI) to enhance the procedural efficacy of catheter ablation in non-paroxysmal atrial fibrillation (NPAF) patients, they are not required in all NPAF patients.
METHODS AND RESULTS:
Eighty consecutive NPAF patients refractory to antiarrhythmic drugs underwent a PVAI-based ablation. Structural heart disease was present in 40% of patients and systolic dysfunction in 21%. After 31 ± 16 months of follow-up, 41% of the patients were free of atrial tachyarrhythmia recurrences after a single procedure. Finally, during a mean follow-up of 25 ± 15 months, 63 of 80 (79%) patients remained in sinus rhythm (SR) after the final procedure (two procedures in 48%, and three in 3%). A Cox regression multivariate analysis revealed that left atrial volume (LAV) was the only independent predictor of atrial tachyarrhythmia recurrences not only after single procedures (p = 0.027), but also after the final procedures (p = 0.001). Ten patients (13%) needed ablation for concomitant atrial tachycardias originating from the left atrium and right atrium other than common atrial flutter. Repeat ablation procedures increased the best cut-off value for predicting recurrences analyzed by receiver operating characteristic curves, from 86 mL (sensitivity 70%, specificity 64%) to 92 mL (sensitivity 71%, specificity 78%).
PVAI-based ablation strategies could achieve SR maintenance in almost 80% of NPAF patients after multiple procedures during long-term follow-up. The preprocedural LAV was an important predictor of the procedural outcome.