The Difference of Predictors for Recurrence After Catheter Ablation of Non-Paroxysmal Atrial Fibrillation According to Follow-Up Period

Abstract

SummaryThe aim of this study was to assess the clinical and echocardiographic predictors for the recurrence of persistent atrial fibrillation (AF) after ablation during a long-term period.A total of 130 patients with persistent AF who had undergone radiofrequency catheter ablation (RFCA) were enrolled. We analyzed the relation between clinical parameters, echocardiographic parameters, and AF recurrences at 6 months, 1 year, and 2 years after ablation.During the 2-year follow-up, AF recurred in 61 patients (46.6%). In the 6 month follow-up, AF recurrence was associated only with total ablation time only. However, during the 1-year and 2-year follow-up periods, the presence of hypertension, impaired left atrial (LA) emptying fraction (eF) (≤ 20%), decreased LA appendage (LAA) emptying velocity (≤ 20 cm/sec), and LAAeF (≤ 20%) were correlated with AF recurrence (odds ratio [OR] = 1.87, 2.45, 1.93, and 2.15 respectively, P = 0.016, 0.004, 0.029, and 0.004 respectively). Among these factors, impaired LAeF was the only independent predictor of AF recurrence in multivariate analysis (OR = 2.81, P = 0.012).In patients with persistent AF who had undergone RFCA, the best predictor of AF recurrence after ablation varied according to the follow-up period. Diminished LA function was the only predictor of recurrence in the 2-year follow-up. Pre-procedural assessment of LA function might be helpful in selecting those patients who would benefit from RFCA. (Int Heart J 2014; 55: 312-318) Key words: Atrial fibrillation recurrence, Left atrial function, Radiofrequency catheter ablation, Echocardiographic predictors R adiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has evolved as an effective therapeutic option in the last decade. RFCA is considered to be a potentially curative treatment to restore sinus rhythm (SR) by eliminating the focus of arrhythmia and modifying the left atrial (LA) structural substrate of AF. However, the recurrence rate after RFCA remains unsatisfactory (15% to ≥ 50%) depending on the ablation strategy and the type of AF.1,2) RFCA is an expensive procedure with potentially critical complications. 3)Thus, it is crucial to identify those patients who are most likely to benefit from AF ablation with respect to restoration of the SR. Several clinical parameters, biomarkers, and imaging parameters have been reported to predict AF recurrence after RFCA. The reported predictors of recurrence after ablation are the presence of hypertension, long duration of AF, prolonged procedural time, enlarged LA diameter (LAD), or increased LA volume (LAV) and decreased LA function. [4][5][6][7][8][9] However, there is no consensus regarding the risk factors for recurrence because of heterogeneities in the study population, differences in the follow-up period, and differences in the type of AF.Echocardiography has a well-recognized and essential role in the current guidelines for the assessment of cardiac structure and function in patients with AF.10) Several echocardiographic parameters for predicting th...

Comparison of Empiric Isolation and Conventional Isolation of Superior Vena Cava in Addition to Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation

“…20,21) Although many patients with late recurrence after PAF ablation had reconnected PVs, a smaller percentage of patients undergoing repeat procedures for AF recurrence were found to have non-PV foci that may not have been identified or targeted during the initial procedure. 22) About 4% to 42% of patients having repeat ablation procedures for paroxysmal AF need ablation of non-PV foci during the follow-up procedure.…”

Effect of pulmonary vein isolation on left atrial appendage flow in paroxysmal atrial fibrillation

“…5,6 More importantly, the role of reduced LAAEFV in thrombogenesis and stroke has been studied fairly well [7][8][9][10][11] and available data suggest that it may also be correlated with endpoints regarding rhythm control. Indeed, higher LAAEFV has been suggested to be an independent predictor of sinus rhythm maintenance after electrical cardioversion, 12 radiofrequency (RF) ablation for paroxysmal or persistent AF, 4,[13][14][15][16][17] or balloon cryoablation for paroxysmal AF. 18,19 In the present study, we sought to prospectively evaluate LAAEFV changes in a short-term follow-up period (…”

Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation

“…2,3) Doppler transesophageal echocardiography (TEE) measurement of blood flow velocity in the left atrial (LA) appendage (LAA) and the presence of LA spontaneous echocardiographic contrast (LASEC) have been used to assess the severity of blood stasis, a risk factor for thrombus formation and stroke. [4][5][6] Previous reports have shown that dense LASEC, decreased LAA flow velocity (LAA-FV), and complex aortic plaques on TEE are independent risk factors for subsequent thromboembolic events. [7][8][9] Although TEE yields high-resolution dynamic images of LA, 4,10) this method is relatively invasive and low-throughput.…”