title: Predictors of recurrence following radiofrequency ablation for persistent atrial fibrillation.
abstract: OBJECTIVE
  To establish clinical factors affecting success in persistent atrial fibrillation (AF) ablation.
  
  
  RESULTS
  Wide area circumferential ablation with linear and electrogram-based left atrial (LA) ablation was performed in 191 consecutive patients for persistent AF. After mean follow-up of 13.0 ± 8.9 months, overall success was 64% requiring a mean of 1.5 procedures. Single procedure success rate was 32%. Left atrial size was a univariate predictor of recurrence after a single procedure (P =0.04). Only LA size [hazard ratio (HR) 1.05/mm with 95% confidential interval (CI) 1.02-1.08] was an independent predictor of recurrence after a single procedure. Only LA size was a univariate predictor of recurrence after multiple procedures (P < 0.01). Left atrial size (HR 1.07/mm with 95% CI 1.02-1.11) and hypertrophic cardiomyopathy (HCM; HR 2.42 with 95% CI 1.06-5.55) were independent predictors of recurrence after multiple procedures. Ablation strategy did not affect success after a single procedure. Left atrial size of <43 mm predicted long-term success with a sensitivity of 92%, specificity 52%, positive predictive value 49%, and negative predictive value 93%. With LA size >43 mm, HCM (HR 3.09 with 95% CI 1.70-7.5) and AF duration (HR 1.07/year with 95% CI 1.00-1.13) were independent predictors of recurrence.
  
  
  CONCLUSIONS
  Left atrial size is the major independent determinant of AF recurrence after ablation for persistent AF. This has important implications for patient selection for persistent AF ablation and the evaluation of AF ablation clinical trial results.
authors.affiliation: The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: James W
authors.initials: JW
authors.lastname: McCready
authors.forename: Tom
authors.initials: T
authors.lastname: Smedley
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
authors.forename: Syed Y
authors.initials: SY
authors.lastname: Ahsan
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Segal
authors.forename: Edward
authors.initials: E
authors.lastname: Rowland
authors.forename: Martin D
authors.initials: MD
authors.lastname: Lowe
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Chow
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography