title: Documentation of pulmonary vein isolation improves long term efficacy of persistent atrial fibrillation catheter ablation.
abstract: BACKGROUND
  The aim of this study was to investigate the efficacy of catheter ablation in the treatment of persistent atrial fibrillation (AF) and the predictors of arrhythmia recurrence.
  
  
  METHODS
  Absence of atrial tachyarrhythmia (AT) recurrence during a mid-term follow-up was correlated with several clinical and procedural characteristics in a population of 82 patients aged 20-70 years who had experienced at least one documented relapse of persistent AF during a single trial of antiarrhythmic drug therapy. Electrophysiological success of ablation was declared when all identified PVs were isolated (confirmation of entry and exit block). Patients were followed for a maximum of 24 months after the blanking period with outpatient visits, ECG recordings, 24-hour Holter monitoring, and weekly transtelephonic monitoring for 30s.
  
  
  RESULTS
  Electrophysiological success was documented in 38/82 (46.3%) patients. During a mean follow-up of 24.7 ± 4.2 months, 69/82 (84.1%) patients presented at least one episode of AT after the 2 month blanking period. According to univariate and multivariate logistic regression analyses, only an electrophysiologically successful ablation significantly correlated with the absence of documented AT relapse (OR 5.32, 95% CL 1.02-27.72; p=.0472).
  
  
  CONCLUSIONS
  Mid-term outcome of a single procedure of catheter ablation without the adjunction of antiarrhythmic drug therapy is poor in patients with persistent AF. Documented PV isolation is useful to increase the success rate of circumferential PV ablation even in persistent AF patients.
authors.affiliation: Department of Cardiological, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy. Electronic address: emanuele.bertaglia@sanita.padova.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bertaglia
authors.affiliation: Casa di Cura Mediterranea, Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
authors.affiliation: Ospedale Civile, Ciriè, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Senatore
authors.affiliation: Ospedale Sant'Anna, Ferrara, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pratola
authors.affiliation: Ospedale Civile Cosma, Camposampiero, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Verlato
authors.affiliation: Heart Hospital, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Lowe
authors.affiliation: University of Tampere, Tampere, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Raatikainen
authors.affiliation: Ospedale San Giovanni, Roma, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lamberti
authors.affiliation: Casa di Cura San Michele, Maddaloni, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Turco
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004282:Documentation; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult
keywords: Catheter ablation; Persistent atrial fibrillation; Pulmonary vein isolation; Transtelephonic monitoring