title: Selection for atrial fibrillation ablation: Importance of diastolic function grading.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) has become an accepted therapy for patients with atrial fibrillation (AF) and the indications have widened to include non-paroxysmal AF-patients. Maintenance of sinus rhythm after PVI can be adversely affected by clinical or echocardiographic parameters, which should be clearly identified.
  
  
  RESULTS
  After baseline clinical and echocardiographic evaluations, PVI was performed in patients with paroxysmal or non-paroxysmal AF. The follow-up strategy after PVI included: (1) clinical follow up, 12-lead electrocardiography (ECG) and 24-h ECG every 3 months, (2) trans-telephonic ECGs twice daily and when symptomatic (over 4 weeks) every 3 months, or (3) continuous monitoring via implanted devices. A recurrence was an atrial arrhythmia lasting >30s. All 340 PVI procedures of 229 patients were analyzed. On average, 1.5 PVI procedures per patient (range, 1-6 PVI) were performed. The mean age was 58±11 years (73% male) with 109 paroxysmal and 120 non-paroxysmal AF cases. Clinical follow-up with 12-lead ECGs, 24-h ECGs, trans-telephonic ECGs, and implanted devices was complete in 100%, 63%, 51%, and 16% of cases, respectively. The overall one-year recurrence rate of 59% (range, 24-82%) was dependent on grades of diastolic function (normal - dysfunction grade III) in a multivariable analysis model. Patients with normal diastolic function had the lowest recurrence rates of 24% and 49% after 1 and 3 years of follow-up, respectively (p<0.0001).
  
  
  CONCLUSIONS
  Diastolic function could serve as a simple summary predictor for AF recurrence, and would facilitate clinical decision-making in AF treatment.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Austria. Electronic address: thomas.pezawas@meduniwien.ac.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pezawas
authors.affiliation: Department of Cardiology, Medical University of Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Binder
authors.affiliation: Section of Medical Statistics, Medical University of Vienna, Austria.
authors.forename: Robin
authors.initials: R
authors.lastname: Ristl
authors.affiliation: Section of Medical Statistics, Medical University of Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schneider
authors.affiliation: Department of Cardiology, Medical University of Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stojkovic
authors.affiliation: Department of Cardiology, Medical University of Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schukro
authors.affiliation: Department of Cardiology, Medical University of Vienna, Austria.
authors.forename: Herwig
authors.initials: H
authors.lastname: Schmidinger
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D003971:Diastole / Q000502:physiology*; D004562:Electrocardiography / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D012008:Recurrence; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Atrial fibrillation; Diastolic function; Pulmonary vein isolation