Early stage of left atrium remodelling predicts better outcome in long-term follow-up of atrial fibrillation ablation.
BACKGROUND
Radiofrequency catheter ablation (RFCA) has been increasingly used for the treatment of patients with symptomatic atrial fibrillation (AF).


OBJECTIVE
To identify simple pre-procedural success predictors of RFCA in patients with AF.


RESULTS
It comprised 294 consecutive patients (mean age 54 ± 11 years, 71% male) with symptomatic AF (28% - paroxysmal with short episodes (< 12 h); 50% - paroxysmal with episodes ≥ 12 h and < 7 days; 11.5% - persistent; 10.5% - long standing persistent), having undergone the first RFCA. Before RFCA, all patients underwent pulmonary vein (PV) anatomy imaging and echocardiographic left atrium diameter (LAD) evaluation. PV periostial or antral isolation guided by electroanatomical mapping was performed with additional lines or complex fractionated electrograms ablation (if required). Outcomes were defined as clinical success (complete or improvement) or failure. After a mean follow-up of 36.9 ± 13 months, clinical success was observed in 90.5% of patients, made up of 47.3% complete success, and 43.2% improvement. Patients with short AF episodes underwent fewer procedures (1.6 vs. 2, p = 0.026) and had the highest clinical (97.6%) and complete (63.9%) success rates. AF episodes < 12 h (p < 0.001), LAD < 4 cm (p = 0.01) and male gender (p = 0.002) independently predicted RFCA long-term clinical success. PV anatomy did not correlate with RFCA outcome. A trend was observed towards a larger number of procedures in patients with atypical PV anatomy (p = 0.059).


CONCLUSIONS
AF ablation should be performed in the early stage of AF, before structural remodelling development.
Department of Cardiac Arrhythmias, Institute of Cardiology, Warsaw, Poland. jzakrzewska@ikard.pl.
Joanna
J
Zakrzewska-Koperska
Paweł
P
Derejko
Franciszek
F
Walczak
Piotr
P
Urbanek
Robert
R
Bodalski
Michał
M
Orczykowski
Lukasz
L
Kalińczuk
Zbigniew
Z
Jedynak
Ilona
I
Michałowska
Artur
A
Oręziak
Maria
M
Bilińska
Andrzej
A
Przybylski
Lukasz
L
Szumowski
D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D064752:Atrial Remodeling; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D016896:Treatment Outcome