title: Predictors of recurrence after a repeat ablation procedure for paroxysmal atrial fibrillation: role of left atrial enlargement.
abstract: OBJECTIVE
  This study sought to explore the predictors of recurrence in patients with paroxysmal atrial fibrillation (AF) undergoing repeat catheter ablation, especially the impact of left atrial (LA) remodelling after the original procedure on the outcome of repeat procedure.
  
  
  RESULTS
  Ninety-five patients undergoing repeat ablation were enrolled in this study. Repeat procedure endpoints were pulmonary vein isolation, linear block when linear ablation is performed, and non-inducibility of atrial tachyarrhythmia by burst pacing. Patients with LA enlargement between the pre-original procedure and pre-repeat procedure were categorized as Group 1 (35 patients), while individuals with no change or decrease of LA diameter were categorized as Group 2 (60 patients). The mean duration from the original procedure to the repeat procedure was 12 months (1-40 months). After 29.6 ± 20.5 (3-73) months follow-up from the repeat procedure, 33 patients experienced recurrence (34.7%). The recurrence rate was significantly higher in Group 1 than in Group 2 (51.4 VS. 25.0%, P = 0.017). In univariate analysis, LA remodelling was the only predictor of recurrence. In multivariate analysis, after adjustment for age and LA diameter, Group 1 had a greater risk of recurrence after the repeat procedure (hazard ratio = 2.22, 95% confidence interval: 1.02-4.81, P = 0.043).
  
  
  CONCLUSIONS
  Left atrial enlargement after undergoing the original catheter ablation of paroxysmal AF was an independent risk factor of recurrence after repeat ablation.
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Ri-Bo
authors.initials: RB
authors.lastname: Tang
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Xian-Liang
authors.initials: XL
authors.lastname: Yan
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Jian-Zeng
authors.initials: JZ
authors.lastname: Dong
authors.affiliation: Center for Arrhythmia Research, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Kalifa
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: De-Yong
authors.initials: DY
authors.lastname: Long
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Rong-Hui
authors.initials: RH
authors.lastname: Yu
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Jun-Ping
authors.initials: JP
authors.lastname: Kang
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Jia-Hui
authors.initials: JH
authors.lastname: Wu
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Cai-Hua
authors.initials: CH
authors.lastname: Sang
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Man
authors.initials: M
authors.lastname: Ning
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Chen-Xi
authors.initials: CX
authors.lastname: Jiang
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Salim
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing 100029, China chshma@vip.sina.com.
authors.forename: Chang-Sheng
authors.initials: CS
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Left atrial remodelling; Repeat procedure