Impact of Atrial Fibrillation Termination Site and Termination Mode in Catheter Ablation on Arrhythmia Recurrence

• Published in: Circulation Journal 2014, Vol.78(1), pp.78-84
• Main Authors: Miyazaki, Shinsuke, Taniguchi, Hiroshi, Kusa, Shigeki, Uchiyama, Takashi, Nakamura, Hiroaki, Hachiya, Hitoshi, Hirao, Kenzo, Iesaka, Yoshito
• Format: Article
• Language: English
• Subjects: Aged; Atrial fibrillation; Atrial Fibrillation - epidemiology; Atrial Fibrillation - prevention & control; Catheter Ablation; Female; Humans; Male; Middle Aged; Persistent atrial fibrillation; Recurrence; Tachycardia, Ectopic Atrial - epidemiology; Tachycardia, Ectopic Atrial - prevention & control
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-13-0838

Background: Although atrial fibrillation (AF) termination has been reported as a predictor of clinical outcome after persistent AF (PsAF) ablation, the relationship between AF termination site and mode and clinical outcome has not been fully evaluated. Methods and Results: A total of 135 patients (62±9 years) underwent their first ablation procedure for PsAF (76 longstanding PsAF). With an endpoint of AF termination, the ablation procedure was performed sequentially in the following order: pulmonary vein (PV) antrum isolation, and left atrial and right atrial substrate modification. AF termination was achieved in 69 patients (51%; 24 at the PV antrum, and 45 in the atrium; direct conversion to sinus rhythm in 21, and atrial tachycardia [AT] in 48). With a mean of 1.7±0.7 procedures/patient, 100 patients (74%) were free from atrial tachyarrhythmia (ATa) during a median of 15.0 months of follow-up. During the initial procedure, the AF termination site (atrium vs. PV antrum, hazard ratio [HR], 1.38; 95% confidence interval [CI]: 0.72–3.77; no termination vs. PV antrum, HR, 2.32; 95% CI: 1.26–6.30; P=0.023) and mode (AT vs. sinus rhythm, HR, 1.47; 95% CI: 0.77–4.01; no termination vs. sinus rhythm, HR, 2.38; 95% CI: 1.26–6.46; P=0.017) were independent predictors of ATa recurrence after the last ablation procedure. Conclusions: The site and mode of AF termination during the index ablation procedure predict ATa recurrence following multiple catheter ablation procedures for PsAF.  (Circ J 2014; 78: 78–84)