title: Clinical predictors of arrhythmia recurrences following pulmonary vein antrum isolation for atrial fibrillation: predicting arrhythmia recurrence post-PVAI.
abstract: BACKGROUND
  Pulmonary vein antrum isolation (PVAI) is an accepted treatment for atrial fibrillation (AF) refractory to medical therapy. The purpose of this study was to identify the patient, procedural, and follow-up factors associated with arrhythmia recurrences following PVAI.
  
  
  RESULTS
  Clinical data were prospectively collected on all 385 consecutive patients who had 530 PVAI (age 58 ± 11 years, 63% paroxysmal AF-PAF, follow-up 2.8 ± 1.2 years) between February 2004 and March 2009. ECGs were recorded at each follow-up visit with Holter monitoring 1, 3, 6, and 12 months following PVAI and every 6 months thereafter. Recurrences < 3 months post-PVAI were defined as early, 3 months-1 year post-PVAI as late, and > 1 year post-PVAI as very late. Relationship between predictor variables and outcomes was modeled using Cox proportional hazards analysis. Late recurrences occurred in 42% with a lower rate among PAF versus non-PAF patients (39% vs 56%, P = 0.001). Of the 256 patients with ≥ 1-year follow-up, 121 (47%) had no arrhythmia off antiarrhythmic drugs (AADs) 1 year post-PVAI; 36 (30%) of these had a very late recurrence. In multivariate analysis, non-PAF, hypertension, and prior AAD failure predicted recurrence. When entered into the model, early recurrences remained the only predictor of late recurrences.
  
  
  CONCLUSIONS
  Patients with non-PAF, hypertension, and prior failure of multiple AAD were more likely to experience arrhythmia recurrence post-PVAI. Early recurrences were the strongest predictor of late recurrences. Late and very late recurrences following PVAI were common and should be considered when planning long-term AF patient management.
authors.affiliation: Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Richard
authors.initials: R
authors.lastname: Oosthuizen
authors.forename: Lauren
authors.initials: L
authors.lastname: Zarnett
authors.forename: Vidal
authors.initials: V
authors.lastname: Essebag
authors.forename: Ratika
authors.initials: R
authors.lastname: Parkash
authors.forename: Catherine
authors.initials: C
authors.lastname: Seabrook
authors.forename: Marianne
authors.initials: M
authors.lastname: Beardsall
authors.forename: Bernice
authors.initials: B
authors.lastname: Tsang
authors.forename: Zaev
authors.initials: Z
authors.lastname: Wulffhart
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002170:Canada; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome