title: Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome.
abstract: BACKGROUND
  Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intraprocedural AF termination and outcome.
  
  
  OBJECTIVE
  The purpose of this study was to test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome.
  
  
  METHODS
  In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity), and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage and proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination.
  
  
  RESULTS
  AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared with 16 patients without termination (P<.05). AFCL was prolonged in both groups. From receiver operating characteristics analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with a positive predictive value of 96%, negative predictive value of 53%, sensitivity of 71%, and specificity of 91%. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF.
  
  
  CONCLUSIONS
  Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence.
authors.affiliation: Hôpital de Haut-Lévèque, Bordeaux, France.
authors.forename: Andrei
authors.initials: A
authors.lastname: Forclaz
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Narayan
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherr
authors.forename: Nick
authors.initials: N
authors.lastname: Linton
authors.forename: Amir S
authors.initials: AS
authors.lastname: Jadidi
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Lena
authors.initials: L
authors.lastname: Rivard
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Laurent
authors.initials: L
authors.lastname: Uldry
authors.forename: Matthew
authors.initials: M
authors.lastname: Wright
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Xingpeng
authors.initials: X
authors.lastname: Liu
authors.forename: Olivier
authors.initials: O
authors.lastname: Xhaet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.forename: Sébastien
authors.initials: S
authors.lastname: Knecht
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D012680:Sensitivity and Specificity; D016896:Treatment Outcome