Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: a prospective study
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
25576779
DOI
10.1016/j.hrthm.2015.01.004
PII: S1547-5271(15)00005-3
Knihovny.cz E-resources
- Keywords
- Atrial fibrillation, Long-standing persistent atrial fibrillation, Noninducibility, Outcome, Sinus rhythm restoration,
- MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Time MeSH
- Electrophysiologic Techniques, Cardiac MeSH
- Atrial Fibrillation * diagnosis drug therapy epidemiology surgery MeSH
- Risk Assessment MeSH
- Catheter Ablation * adverse effects methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Complications * diagnosis epidemiology therapy MeSH
- Disease-Free Survival MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Recurrence MeSH
- Registries MeSH
- Reoperation MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic epidemiology MeSH
- Names of Substances
- Anti-Arrhythmia Agents MeSH
BACKGROUND: The impact of restoring sinus rhythm (SR) by initial ablation in patients with long-standing persistent atrial fibrillation (LSPAF) is not fully established. OBJECTIVE: The purpose of this study was to investigate the prognostic value of SR restoration at the initial procedure and arrhythmia noninducibility at the final repeat procedure for long-term outcome. METHODS: A total of 203 patients (22% female; age 59 ± 9 years) underwent stepwise catheter ablation for LSPAF. RESULTS: The procedural end-point of SR restoration was achieved in 50% of patients. During follow-up (median 48 months) and after 1.7 procedures per patient, 72% of patients were free from arrhythmia off antiarrhythmic drugs. Failure to restore SR was independently predicted by left atrial (LA) long-axis diameter ≥68 mm (relative risk [RR] 1.55, P = .03], proportion of high-voltage LA sites <20% (RR 1.62, P = .02), and left atrial appendage (LAA) atrial fibrillation cycle length (AFCL) <155 ms (RR 1.5, P = .05). Arrhythmia recurrence after the initial procedure was predicted by SR nonrestoration (RR 2.99, P <.000001) and LAA AFCL ≥155 ms (RR 1.90, P = .0002). Arrhythmia recurrence after the final procedure was predicted by SR nonrestoration at the initial procedure (RR 2.83, P = .0007), persistent AF duration ≥24 months (RR 2.74, P = .002), LAA outflow velocity <40 cm/s (RR 2.21, P = .006), and LAA AFCL ≥155 ms (RR 1.92, P = .02). In 115 patients with repeat procedure(s), failure to achieve arrhythmia noninducibility at the final procedure (19% of patients) was associated with arrhythmia recurrence (RR 8.9, P < .000001). CONCLUSION: SR restoration at the initial procedure and arrhythmia noninducibility at the last repeat procedure were major predictors of arrhythmia-free outcome after ablation for LSPAF.
Department of Cardiology Hospital Podlesí Třinec Czech Republic
Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Internal Medicine and Cardiology University Hospital Brno Czech Republic
References provided by Crossref.org
Catheter Ablation for Persistent and Long-Standing Persistent Atrial Fibrillation
