title: Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: results from a multicenter study.
abstract: OBJECTIVE
  The purpose of this prospective multicenter study was to compare results of catheter ablation in patients with paroxysmal atrial fibrillation (PAF) and those with nonparoxysmal atrial fibrillation (NPAF). The impact and the role of repeat catheter ablation were assessed in patients with recurrence.
  
  
  RESULTS
  One thousand four hundred four patients underwent catheter ablation for atrial fibrillation (AF) performed by 12 operators at four institutions using a single technique guided by intracardiac echocardiography. Of these patients, 728 had PAF and 676 had NPAF. Among the NPAF patients, 293 had persistent AF and 383 had long-standing persistent AF. Patients with NPAF had a higher incidence of hypertension and/or structural heart disease (64.8% vs 48.5%, P = .003) and a lower mean left ventricular ejection fraction (53.3% +/- 8.7% vs 55.7 +/- 6.5%, P <.001). All patients underwent antral isolation of all four pulmonary veins and the superior vena cava. At mean follow-up of 57 +/- 17 months, 565 of 728 patients with PAF and 454 of 676 patients with NPAF (77.6% vs 67.2%, P <.001) had freedom from AF after a single ablation procedure. For arrhythmia recurrences, 74.2% (121/163) patients with PAF and 74.8% (166/222) with NPAF underwent repeat ablation, after which 92.4% patients with PAF and 84.0% patients with NPAF remained free from AF.
  
  
  CONCLUSIONS
  Pulmonary vein antrum isolation guided by intracardiac echocardiography results in significant freedom from AF, even when performed by multiple operators in different centers. At least moderate efficacy can be achieved in patients with NPAF, although the success rate is lower than in patients with PAF. Considerably higher success can be achieved in both groups with repeat ablation.
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Subramanyam
authors.initials: S
authors.lastname: Prasad
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Michelle
authors.initials: M
authors.lastname: Williams-Andrews
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cummings
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossillo
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonso
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Kelly
authors.initials: K
authors.lastname: Stewart
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D016896:Treatment Outcome