Predicting factors for atrial fibrillation acute termination during catheter ablation procedures: implications for catheter ablation strategy and long-term outcome.
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.
Lo
Li-Wei
LW
Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Tai
Ching-Tai
CT
Lin
Yenn-Jiang
YJ
Chang
Shih-Lin
SL
Udyavar
Ameya R
AR
Hu
Yu-Feng
YF
Ueng
Kuo-Chang
KC
Tsai
Wen-Chin
WC
Tuan
Ta-Chun
TC
Chang
Chien-Jung
CJ
Kao
Tsair
T
Tsao
Hsuan-Ming
HM
Wongcharoen
Wanwarang
W
Higa
Satoshi
S
Chen
Shih-Ann
SA
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