title: Long-term outcome and preprocedural predictors of atrial tachyarrhythmia recurrence following pulmonary vein antrum isolation-based catheter ablation in patients with non-paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Although various empiric adjunctive ablation techniques are widely performed with pulmonary vein antrum isolation (PVAI) to enhance the procedural efficacy of catheter ablation in non-paroxysmal atrial fibrillation (NPAF) patients, they are not required in all NPAF patients.
  
  
  RESULTS
  Eighty consecutive NPAF patients refractory to antiarrhythmic drugs underwent a PVAI-based ablation. Structural heart disease was present in 40% of patients and systolic dysfunction in 21%. After 31 ± 16 months of follow-up, 41% of the patients were free of atrial tachyarrhythmia recurrences after a single procedure. Finally, during a mean follow-up of 25 ± 15 months, 63 of 80 (79%) patients remained in sinus rhythm (SR) after the final procedure (two procedures in 48%, and three in 3%). A Cox regression multivariate analysis revealed that left atrial volume (LAV) was the only independent predictor of atrial tachyarrhythmia recurrences not only after single procedures (p = 0.027), but also after the final procedures (p = 0.001). Ten patients (13%) needed ablation for concomitant atrial tachycardias originating from the left atrium and right atrium other than common atrial flutter. Repeat ablation procedures increased the best cut-off value for predicting recurrences analyzed by receiver operating characteristic curves, from 86 mL (sensitivity 70%, specificity 64%) to 92 mL (sensitivity 71%, specificity 78%).
  
  
  CONCLUSIONS
  PVAI-based ablation strategies could achieve SR maintenance in almost 80% of NPAF patients after multiple procedures during long-term follow-up. The preprocedural LAV was an important predictor of the procedural outcome.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: koichiro@qf6.so-net.ne.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ejima
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Arai
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nuki
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Uematsu
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Fukushima
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hoshi
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Tetsuyuki
authors.initials: T
authors.lastname: Manaka
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Kyomi
authors.initials: K
authors.lastname: Ashihara
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Shoda
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D002306:Cardiac Volume; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D013610:Tachycardia / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Persistent atrial fibrillation; Predictor; Pulmonary vein antrum isolation