Prognostic criteria of success and recurrence in circumferential ablation for the treatment of atrial fibrillation.
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.
Maciel
Washington
W
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
Andréa
Eduardo
E
Araújo
Nilson
N
Carvalho
Hecio
H
Belo
Luiz Gustavo
LG
Siqueira
Leonardo
L
Munhoz
Claudio
C
Cosenza
Rodrigo
R
Mitidieri
Fabiana
F
Atié
Jacob
J
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