title: Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter.
abstract: BACKGROUND
  The aims of this study were to identify predictors of recurrence after catheter ablation of atrial fibrillation (AF) and to report the safety and efficacy of catheter ablation of AF using an irrigated-tip ablation catheter.
  
  
  RESULTS
  Seventy-five consecutive patients (51 men [68%]; age 54 +/- 13 years) with symptomatic drug-refractory paroxysmal (42 patients), persistent (21 patients), or permanent (12 patients) AF underwent catheter ablation of AF using an irrigated-tip ablation catheter and a standard ablation strategy, which involved electrical isolation of all pulmonary veins (PVs) and creation of a cavotricuspid linear lesion. At 10.5 +/- 7.5 months of follow-up following a single (n = 75) or redo ablation procedure (n = 11), 39 (52%) of the 75 patients were free of AF, 10 were improved (13%), and 26 had experienced no benefit from the ablation procedure (35%). Seventy-six percent of patients with paroxysmal AF were free from recurrent AF. The most significant complications were two episodes of pericardial tamponade, mitral valve injury in one patient, two strokes, and complete but asymptomatic PV stenosis in one patient. Cox proportional hazards multivariate regression analysis identified the presence of persistent AF, permanent AF, and age >50 years prior to the ablation are the only independent predictors of AF recurrence after the first PV isolation procedure.
  
  
  CONCLUSIONS
  Catheter ablation of AF using a strategy involving isolation of all PVs and creation of a linear lesion in the cavotricuspid isthmus using cooled radiofrequency energy is associated with moderate efficacy and an important risk for complications. The best results of this procedure are achieved in the subset of patients who are younger than 50 years and have only paroxysmal AF.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0409, USA.
authors.forename: Chandrasekhar R
authors.initials: CR
authors.lastname: Vasamreddy
authors.forename: Lars
authors.initials: L
authors.lastname: Lickfett
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Jayam
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: Zayd
authors.initials: Z
authors.lastname: Eldadah
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D002408:Catheters, Indwelling; D017548:Echocardiography, Transesophageal; D004867:Equipment Design / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome