title: Incidence and predictors of very late recurrence of atrial fibrillation after ablation.
abstract: BACKGROUND
  Radiofrequency catheter ablation can effectively treat patients with refractory atrial fibrillation (AF). Very late AF recurrence (> or = 12 months post-ablation) is uncommon and may represent a unique patient cohort.
  
  
  RESULTS
  A nested case-control study was performed in the cohort who underwent AF ablation at the University of Pennsylvania to characterize patients who develop very late AF recurrence after ablation. The procedure consisted of isolation of pulmonary veins (PVs) demonstrating triggers and elimination of non-PV triggers initiating AF. Twenty-seven (7.9%) patients with very late recurrence were compared to 219 patients without recurrence and > or = 12 months of follow-up. The mean age was 54.6 +/- 11.3 years and 79% were men. Very late recurrence patients more likely weighed >200 lbs (70% vs 55%, P = 0.01); during initial ablation had fewer PVs isolated (2.8 +/- 1.1 vs 3.3 +/- 1.0, P = 0.03); and were less likely to have right inferior PV isolation (37% vs 61%, P = 0.02), less likely to have isolation of all PVs (30% vs 56%, P = 0.01), and more likely to have non-PV triggers (30% vs 11% OR 3.4(95% CI, 1.3-8.7), P = 0.01). PV reconnectivity and new triggers were found in the majority of patients with very late recurrence of AF who underwent repeat ablation.
  
  
  CONCLUSIONS
  Very late recurrence of AF more likely occurred in patients >200 lbs who demonstrated non-PV triggers and did not undergo right inferior PV isolation. The majority of patients undergoing repeat ablation for very late recurrence demonstrated PV reconnectivity and new non-PV and PV triggers not observed during the initial ablation.
authors.affiliation: Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mainigi
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Russo
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Verdino
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011184:Postoperative Period; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors