title: Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation.
abstract: OBJECTIVE
  This study evaluated the role of pre-procedural clinical variables to predict procedural and clinical outcomes of catheter ablation in patients with long-lasting persistent atrial fibrillation (AF).
  
  
  BACKGROUND
  Catheter ablation of persistent AF remains a challenging task.
  
  
  METHODS
  Catheter ablation was performed in 90 patients (76 men, age 57 +/- 11 years) with long-lasting persistent AF. The history of AF, echocardiographic parameters, presence of structural heart disease, and surface electrocardiogram (ECG) AF cycle length (CL) were assessed before ablation and analyzed with respect to procedural termination and clinical outcome. Mean follow-up was 28 +/- 4 months.
  
  
  RESULTS
  Persistent AF was terminated in 76 of 90 patients (84%) by ablation. The duration of continuous AF was shorter (p < 0.0001), the surface ECG AFCL was longer (p < 0.0001), and the left atrium was smaller (p < 0.01) in patients in whom AF was terminated by catheter ablation. The surface ECG AFCL was the only independent predictor of AF termination (p < 0.01). Maintenance of sinus rhythm was associated with a shorter duration of continuous AF (p < 0.0001), a longer surface ECG AFCL (p < 0.001), and a smaller left atrium (p < 0.05) compared with those with recurrent arrhythmia. In multivariate analysis, the surface ECG AFCL and the AF duration predicted clinical success of persistent AF ablation (p < 0.01 and p < 0.05, respectively).
  
  
  CONCLUSIONS
  The surface ECG AFCL is a clinically useful pre-ablation tool for predicting patients in whom sinus rhythm can be restored by catheter ablation. The duration of continuous AF and the surface ECG AFCL are predictive of maintenance of sinus rhythm.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. mattsuu@tc4.so-net.ne.jp
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Matsuo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
authors.forename: Matthew
authors.initials: M
authors.lastname: Wright
authors.forename: Michela
authors.initials: M
authors.lastname: Bevilacqua
authors.forename: Sébastien
authors.initials: S
authors.lastname: Knecht
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Kang-Teng
authors.initials: KT
authors.lastname: Lim
authors.forename: Leonardo
authors.initials: L
authors.lastname: Arantes
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'Neill
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
authors.forename: Jonas
authors.initials: J
authors.lastname: Carlson
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome