title: Atrioventricular nodal reentrant tachycardia with paroxysmal atrial fibrillation: clinical and electrophysiological features and predictors of atrial fibrillation recurrence following elimination of atrioventricular nodal reentrant tachycardia.
abstract: BACKGROUND
  Clinical and electrophysiological characteristics of patients with atrioventricular nodal reentrant tachycardia (AVNRT) and paroxysmal atrial fibrillation (AF) have not been studied in a large patient cohort. We aimed to define the clinical features and cardiac electrophysiological characteristics of these patients, and to examine the incidence and identify predictors of AF recurrences after elimination of AVNRT.
  
  
  RESULTS
  Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) and 497 patients with AVNRT alone undergoing ablation in the same period (Group 2) were studied. There were no significant differences between groups regarding clinical features, except age, which was higher in Group 1 (p<0.001). Presence of atrial vulnerability (induction of AF lasting>30 seconds) and multiple AH jumps (>or=50 ms) before ablation were significantly more prevalent in Group 1 (p<0.001, p=0.010 respectively). During follow-up of 34 +/- 11 months, AF recurred in 10 patients (28%) in Group 1, while 2 patients in Group 2 (0.4%) developed paroxysmal AF (p<0.001). Univariate predictors of AF were: left atrial diameter>40 mm (p=0.001), presence of mitral or aortic calcification (p=0.003), atrial vulnerability after ablation (p=0.015) and valvular disease (p=0.042). However, independent predictors of AF recurrences were left atrial diameter>40 mm (p=0.002) and the presence of atrial vulnerability after ablation (p=0.034).
  
  
  CONCLUSIONS
  In patients with both AVNRT and paroxysmal AF, the recurrence rate of AF after elimination of AVNRT is 28%. Left atrial diameter greater than 40 mm and atrial vulnerability after elimination of AVNRT are independent predictors of AF recurrences in the long term.
authors.affiliation: Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey, 06018. dramasyali@yahoo.com
authors.forename: Basri
authors.initials: B
authors.lastname: Amasyali
authors.forename: Sedat
authors.initials: S
authors.lastname: Kose
authors.forename: Kudret
authors.initials: K
authors.lastname: Aytemir
authors.forename: Ayhan
authors.initials: A
authors.lastname: Kilic
authors.forename: Gulumser
authors.initials: G
authors.lastname: Heper
authors.forename: Hurkan
authors.initials: H
authors.lastname: Kursaklioglu
authors.forename: Atila
authors.initials: A
authors.lastname: Iyisoy
authors.forename: Turgay
authors.initials: T
authors.lastname: Celik
authors.forename: E Bariş
authors.initials: EB
authors.lastname: Kaya
authors.forename: Ersoy
authors.initials: E
authors.lastname: Isik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome