title: Impact of atrial fibrillation termination mode during catheter ablation procedure on maintenance of sinus rhythm.
abstract: BACKGROUND
  Catheter ablation is a common and effective procedure for addressing atrial fibrillation (AF) refractory to antiarrhythmic drugs. AF can be terminated in 3 modes: (1) directly into sinus rhythm (SR); (2) evolving into regular atrial tachycardia (AT) and subsequently into SR; and (3) after direct current (DC) cardioversion if AF persists. Scarce data are available on the relationship between clinical outcomes and termination mode after 1 catheter ablation.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate for the first time the association between 1-year ablation efficacy and termination mode after repeated catheter ablations in patients presenting with persistent or long-standing persistent AF.
  
  
  METHODS
  This prospective study involved 400 consecutive patients (age 62.7 ± 7.2 years) who underwent catheter ablation for drug-refractory persistent AF (4.6 ± 2.4 months) using a stepwise ablation approach.
  
  
  RESULTS
  AF was terminated by radiofrequency application directly into SR in 135 patients; passing through AT into SR in 195 patients; and through DC cardioversion in 70 patients. After 1-year follow-up with repeated Holter monitoring, the percentages of SR maintenance were 72.6%, 80.0%, and 28.6%, respectively (P < .001). Compared with the subjects who were converted directly into SR, the adjusted hazard ratios (HRs) of SR maintenance were significantly lower for those who required DC cardioversion (HR = 0.54; P < .001) and higher for those converted through AT (HR = 1.69; P = .027). The latter association was even stronger in the 104 subjects who required a second procedure (HR = 6.25; P = .001).
  
  
  CONCLUSIONS
  Termination of AF through AT during catheter ablation was more effective than both DC shock and direct SR in maintaining stable SR 1 year after both the first and the second procedures.
authors.affiliation: Cardiology Department, Private Hospital "L. Pierangeli", Pescara, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Faustino
authors.affiliation: Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy. Electronic address: carmine.pizzi@unibo.it.
authors.forename: Carmine
authors.initials: C
authors.lastname: Pizzi
authors.affiliation: Cardiology Department, Private Hospital "L. Pierangeli", Pescara, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Capuzzi
authors.affiliation: Electrophysiology Operating Unit, Cardiovascular Department, "Spirito Santo" Hospital, ASL Pescara, Pescara, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Agricola
authors.affiliation: Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy.
authors.forename: Grazia Maria
authors.initials: GM
authors.lastname: Costa
authors.affiliation: Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; Regional Healthcare Agency of Abruzzo, Abruzzo, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Flacco
authors.affiliation: Sapienza University of Rome, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Marzuillo
authors.affiliation: Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Nocciolini
authors.affiliation: Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; CeSI Biotech, Chieti, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capasso
authors.affiliation: Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; Regional Healthcare Agency of Abruzzo, Abruzzo, Italy; CeSI Biotech, Chieti, Italy.
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012008:Recurrence; D016896:Treatment Outcome
keywords: Atrial fibrillation; Atrial tachycardia; Catheter ablation; DC shock cardioversion; Prognosis