title: Residual arrhythmogenic foci predict recurrence in long-standing persistent atrial fibrillation patients after sinus rhythm restoration ablation.
abstract: BACKGROUND
  The mechanism of persistent atrial fibrillation (AF) is multifactorial, and arrhythmogenic foci (AMF) might be involved in the occurrence of persistent AF. In this study, we examined the electrophysiological features of AMF during and immediately after ablation, and evaluated the relationship between the presence and number of residual AMF on the risk of AF recurrence after a vigorous sinus rhythm restoration ablation in patients with long-standing persistent AF.
  
  
  METHODS
  The study consisted of 117 consecutive patients with persistent AF who underwent catheter ablation (CA). We performed direct cardioversion to restore sinus rhythm before the pulmonary vein (PV) isolation and at the end of the CA. Then we evaluated the features of the AMF inducible with isoproterenol and the pacing-based AF inducibility.
  
  
  RESULTS
  After the completion of ablation, AF could still be induced in 37 of 117 patients (31.6%). Spontaneous PV AMF during CA were observed in 104 of 117 patients (91%), and non-PV AMF in 63 of 117 (54%). Residual non-PV AMF were significantly associated with the pacing-based AF inducibility and an enlarged left atrial volume. In the multivariate analysis, the AF duration (1.01 [range, 1.00-1.02] months; P = 0.012), left atrial volume (1.01 [range, 1.01-1.02] mm; P = 0.006), and residual AMF (3.95 [range, 1.32-11.8] yes, no; P = 0.004) were independent risk factors for recurrent AF.
  
  
  CONCLUSIONS
  Residual AMF are associated with an increased long-term AF recurrence after sinus rhythm restoration ablation for long-standing persistent AF.
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan. Electronic address: drk21cent@gmail.com.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kurotobi
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Kino
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Kazato
authors.initials: K
authors.lastname: Ito
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tonomura
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yano
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Tanaka
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Tsuchida
authors.affiliation: Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
authors.forename: Histohi
authors.initials: H
authors.lastname: Fukumoto
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome