title: Predicting factors for atrial fibrillation acute termination during catheter ablation procedures: implications for catheter ablation strategy and long-term outcome.
abstract: BACKGROUND
  Termination of atrial fibrillation (AF) can be achieved by catheter ablation. It has been used as one of the procedural endpoints for AF ablation.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the factors that predict AF termination and the association with long-term outcomes.
  
  
  METHODS
  Eighty-five consecutive AF patients (33 paroxysmal, 52 nonparoxysmal) underwent three-dimensional mapping and catheter ablation. A stepwise ablation approach included circumferential pulmonary vein (PV) isolation and left atrial (LA) linear ablation, followed by LA and right atrial (RA) electrogram-based (complex fractionated atrial electrogram) ablation. Clinical and electrophysiologic characteristics were assessed to evaluate the predictors of acute AF termination.
  
  
  RESULTS
  In univariate analysis, a diagnosis of paroxysmal AF, shorter AF history, absence of history of heart failure, smaller LA diameter, longer postablation coronary sinus cycle length, lower LA and RA mean dominant frequencies, lower RA max dominant frequency, and higher LA voltage were related to acute termination of AF during ablation. Multivariate analysis showed that smaller LA diameter and lower preablation mean RA dominant frequency were independent predictors of AF termination. Multivariate analysis also showed that larger LA diameter and the presence of RA non-PV ectopy during the index procedure could predict late recurrence during long-term (13 +/- 8 months) follow-up.
  
  
  CONCLUSIONS
  LA size and RA non-PV drivers are important for acute termination of AF and for long-term success. Careful selection of patients, extensive RA mapping, and LA ablation may enhance long-term ablation efficacy.
authors.affiliation: Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Lo
authors.forename: Ching-Tai
authors.initials: CT
authors.lastname: Tai
authors.forename: Yenn-Jiang
authors.initials: YJ
authors.lastname: Lin
authors.forename: Shih-Lin
authors.initials: SL
authors.lastname: Chang
authors.forename: Ameya R
authors.initials: AR
authors.lastname: Udyavar
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Hu
authors.forename: Kuo-Chang
authors.initials: KC
authors.lastname: Ueng
authors.forename: Wen-Chin
authors.initials: WC
authors.lastname: Tsai
authors.forename: Ta-Chun
authors.initials: TC
authors.lastname: Tuan
authors.forename: Chien-Jung
authors.initials: CJ
authors.lastname: Chang
authors.forename: Tsair
authors.initials: T
authors.lastname: Kao
authors.forename: Hsuan-Ming
authors.initials: HM
authors.lastname: Tsao
authors.forename: Wanwarang
authors.initials: W
authors.lastname: Wongcharoen
authors.forename: Satoshi
authors.initials: S
authors.lastname: Higa
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods; D004554:Electric Countershock; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome