Is Pursuit of Termination of Atrial Fibrillation During Catheter Ablation of Great Value in Patients with Longstanding Persistent Atrial Fibrillation?

PARK, YAE M.; CHOI, JONG‐IL; LIM, HONG E.; PARK, SANG W.; KIM, YOUNG‐HOON

Termination of Atrial Fibrillation During Catheter Ablation Predicts Better Outcome. Background: The reliable endpoint for ablation of longstanding persistent atrial fibrillation (LPAF) has not been clearly established. Methods and Results: This study included 140 patients who underwent catheter ablation for drug-refractory LPAF. A stepwise ablation approach included circumferential pulmonary vein isolation followed by left atrial and right atrial complex fractionated electrogram-guided ablation. Atrial fibrillation (AF) was terminated by radiofrequency application during catheter ablation in 95 patients (67.9%). Among them, 33 patients (23.6%) converted to sinus rhythm directly, whereas 62 patients (44.3%) via atrial tachycardias (ATs). Patients in whom AF terminated during the index procedure had a lower recurrence rate of atrial arrhythmia than patients in whom AF did not terminate (45.3% vs 68.9%, P = 0.009, follow-up 18.7 ± 7.6 months). Among patients in whom AF terminated, there was no significant difference in recurrence rate according to the termination mode, whether converted to AT or not (P = NS). However, patients who converted to AT had a higher recurrence rate of AT (54.8% vs 81%; P = 0.016). Multivariable logistic regression analysis demonstrated that termination of AF during ablation (HR 0.440; 95% CI: 0.200-0.969, P = 0.041) and structural heart disease (HR 2.633; 95% CI: 1.211-5.723; P = 0.015) were significant independent factors predicting the recurrence of atrial arrhythmia. Conclusions: Termination of AF during catheter ablation is associated with a better clinical outcome in patients with LPAF. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1051-1058, October 2012)

ATRIAL fibrillation; CATHETER ablation; CHI-squared test; CHRONIC diseases; REPORTING of diseases; ELECTROPHYSIOLOGY; FISHER exact test; HEART atrium; PATIENT aftercare; LONGITUDINAL method; HEALTH outcome assessment; STATISTICS; OPERATIVE surgery; SURVIVAL analysis (Biometry); T-test (Statistics); TACHYCARDIA; DISEASE relapse; DATA analysis; MULTIPLE regression analysis; TREATMENT effectiveness; DESCRIPTIVE statistics; KAPLAN-Meier estimator

Journal of Cardiovascular Electrophysiology, 2012, Vol 23, Issue 10, p1051

1045-3873

Academic Journal

10.1111/j.1540-8167.2012.02370.x