SHODA Morio    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Endowed Professor
Article types	Original article
Language	English
Peer review	Peer reviewed
Title	Impact of a prolonged interatrial conduction time for predicting the recurrence of atrial fibrillation after circumferential pulmonary vein isolation of persistent atrial fibrillation.
Journal	Formal name：Heart and vessels Abbreviation：Heart Vessels ISSN code：0910-8327/1615-2573
Domestic / Foregin	Domestic
Publisher	Springer JAPAN
Volume, Issue, Page	34(4),pp.616-624
Author and coauthor	HIGUCHI Satoshi†, EJIMA Koichiro*, SHODA Morio, YAMAMOTO Eri, IWANAMI Yuji, YAGISHITA Daigo, HAGIWARA Nobuhisa
Publication date	2019/04
Summary	There are some cases that are difficult to cure with only circumferential pulmonary vein isolation (CPVI) of persistent atrial fibrillation (PerAF). Recently, prolonged interatrial conduction times (IACTs), which seem to be associated with progressive remodeled atria, have been reported as a predictor of new-onset AF. This study aimed to investigate the prognostic value of a prolonged IACT for predicting AF recurrences after CPVI of PerAF. One hundred thirteen patients who underwent CPVI without an empirical substrate modification of PerAF were retrospectively analyzed. The IACT was defined as the interval from the earliest P-wave onset on the ECG to the latest activation in the coronary sinus and was measured after achieving the CPVI and conversion to sinus rhythm. During a mean 22.7-month follow-up after the initial procedure, 56 patients (50%) had AF recurrences. Patients with AF recurrence had a longer IACT than those without AF recurrence (p < 0.001). The best discriminative cut-off value for the IACT was 123 ms (sensitivity 53%, specificity 85%). In a Cox multivariate analysis, a prolonged IACT of ≥ 123 ms was the only independent predictor (hazard ratio: 2.38; 95% confidence interval: 1.36-4.16, p = 0.002) of being associated with the incidence of an AF recurrence. Even after multiple CPVI procedures, patients with an IACT ≥ 123 ms had a higher AF recurrence rate than those with an IACT < 123 ms (p = 0.002). In conclusion, a prolonged IACT of ≥ 123 ms may be a useful marker for predicting AF recurrences after both initial and multiple CPVI procedures for PerAF.
DOI	10.1007/s00380-018-1272-8
PMID	30291411