title: Prognostic criteria of success and recurrence in circumferential ablation for the treatment of atrial fibrillation.
abstract: OBJECTIVE
  To analyze the success of circumferential ablation of atrial fibrillation and to investigate possible clinical and electroanatomic predictors of recurrence of cardiac arrhythmia.
  
  
  METHODS
  104 consecutive patients free of structural heart disease and refractory to at least two antiarrhythmic drugs, and undergoing circumferential ablation for the treatment of paroxysmal/persistent atrial fibrillation were analyzed. Seventy two patients were males and the mean age of the group was 58.6 + 10.9 years. The procedure consisted of a single transseptal puncture and three-dimension mapping using the CARTO system to acquire points in the left atrium and pulmonary veins. Radiofrequency applications were performed encircling the pulmonary vein ostea, up to a > or = 80% reduction of the atrial potential amplitude. One additional line was created in the mitral isthmus and another in the cavotricuspid isthmus. Total left atrium volume, area ablated around the pulmonary veins, and completeness of the ablation line (complete or incomplete line) were analyzed. A line was considered complete when the distance between two contiguous radiofrequency application points was lower than 10mm.
  
  
  RESULTS
  In a mean 18-month follow-up, 87 patients were in sinus rhythm (84%), and 17 patients presented recurrence (16%). In the multivariate analysis, only the left atrial volume (p<0.0001) and complete ablation (p<0.05) were independent predictors of recurrence.
  
  
  CONCLUSIONS
  The results suggest that the left atrial volume and the presence of complete ablation are predictive of recurrence of atrial fibrillation.
authors: Clínica São Vicente, Instituto Estadual de Cardiologia Aloysio de Castro e Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. wmaciel@cardiol.br
authors: Washington
authors: W
authors: Maciel
authors: Eduardo
authors: E
authors: Andréa
authors: Nilson
authors: N
authors: Araújo
authors: Hecio
authors: H
authors: Carvalho
authors: Luiz Gustavo
authors: LG
authors: Belo
authors: Leonardo
authors: L
authors: Siqueira
authors: Claudio
authors: C
authors: Munhoz
authors: Rodrigo
authors: R
authors: Cosenza
authors: Fabiana
authors: F
authors: Mitidieri
authors: Jacob
authors: J
authors: Atié
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome