Clinical characteristics of patients with persistent atrial fibrillation successfully treated by left atrial ablation.
BACKGROUND
We sought to characterize patients with persistent atrial fibrillation (AF) who were successfully treated by ablation targeting the left atrium (LA).


RESULTS
Ninety-three patients (58±10 years, 79 male) undergoing ablation of persistent AF were studied. During the first procedure, ablation was performed in the LA and coronary sinus, consisting of pulmonary vein isolation, linear ablation, and electrogram-based ablation. During follow-up after the first procedure, 35 patients (38%) remained free from tachyarrhythmias, 27 patients (29%) had atrial tachycardia, and 31 patients (33%) had AF. Duration of persistent AF according to medical history and whether AF was terminated by ablation were associated with the outcome (P=0.005, P=0.004, respectively). In multivariate analysis, the duration of persistent AF was the only predictor of freedom from AF (sinus rhythm or atrial tachycardia) (odds ratio, 0.80 for a 1-year increase; 95% confidence interval, 0.67 to 0.95; P=0.01). Of 31 patients in whom AF recurred during follow-up, electrogram-based ablation was performed in the right atrium in 26 patients. Sixteen of those patients (62%) remained free from AF during follow-up. Overall, 82% of patients were free from any tachyarrhythmias at 2-year follow-up after a median of 2 procedures.


CONCLUSIONS
Patients with shorter duration of persistent AF were more likely to be free from AF by LA ablation. Right atrial ablation may provide incremental efficacy in patients who are refractory to LA ablation.
Takahashi
Yoshihide
Y
Yokosuka Kyousai Hospital, Yokosuka, Japan. yoshihide_takahashi@oboe.ocn.ne.jp
Takahashi
Atsushi
A
Kuwahara
Taishi
T
Fujino
Tadashi
T
Okubo
Kenji
K
Kusa
Shigeki
S
Fujii
Akira
A
Yagishita
Atsuhiko
A
Miyazaki
Shinsuke
S
Nozato
Toshihiro
T
Hikita
Hiroyuki
H
Hirao
Kenzo
K
Isobe
Mitsuaki
M
D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000294:innervation* / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome