title: Optimal observation time after completion of circumferential pulmonary vein isolation for atrial fibrillation to prevent chronic pulmonary vein reconnections.
abstract: OBJECTIVE
  To identify predictors of chronic pulmonary vein (PV) reconnection (CPVR) after successful circumferential PV isolation (CPVI) for atrial fibrillation (AF).
  
  
  METHODS
  A total of 718 PVs from 181 consecutive AF patients (141 males, median age 61 years, 92 paroxysmal AF) who underwent a second ablation procedure for recurrent AF were retrospectively analyzed.
  
  
  RESULTS
  During the second procedure, a CPVR was observed in 477 PVs (66.4%) among 169 patients. In a multiple logistic regression analysis, the observation time after the final completion of the PVI (OT-final) was a significant negative predictor (odds ratio 0.980; P<0.001). A receiver operating characteristic analysis demonstrated that the greatest area under the curve was for the OT-final (0.670). At an optimal cutoff of 35 min, the sensitivity and specificity for predicting a CPVR were 66.9% and 60.6%, respectively. By Kaplan Meier analysis, CPVR was more frequent in PVs with an OT-final of <35 min than ≥35 min (log-rank test, P=0.018). In a vessel-by-vessel analysis, the OT-final at all PV sites was a significant negative predictor, while male gender in the right PVs and left-inferior PV, number of RF applications for the ipsilateral CPVI in the right PVs and left-superior PV, and major PV diameter in the left-superior PV were significant positive predictors of a CPVR (all P<0.05).
  
  
  CONCLUSIONS
  An optimal observation time (≥35 min in this study) to determine whether PVI is successfully completed during the initial CPVI for AF may be needed to prevent a CPVR and subsequent AF recurrence thereafter.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan.
authors.forename: Kohki
authors.initials: K
authors.lastname: Nakamura
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kaseno
authors.forename: Naofumi
authors.initials: N
authors.lastname: Tsukada
authors.forename: Takehito
authors.initials: T
authors.lastname: Sasaki
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hayano
authors.forename: Suguru
authors.initials: S
authors.lastname: Nishiuchi
authors.forename: Etsuko
authors.initials: E
authors.lastname: Fuke
authors.forename: Yuko
authors.initials: Y
authors.lastname: Miki
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Keijiro
authors.initials: K
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kataoka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takaoka
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Nobusada
authors.initials: N
authors.lastname: Funabashi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed
keywords: Atrial fibrillation; Chronic pulmonary vein reconnections; Circumferential pulmonary vein isolation; Optimal observation time