Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Endowed Associate Professor
Article types Original article
Language English
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
Abbreviation:J Cardiol
ISSN code:09145087/18764738
Domestic / ForeginDomestic
Publisher Elsevier
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
Publication date 2014/07
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.

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.
DOI 10.1016/j.jjcc.2013.11.010