title: Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: a prospective study.
abstract: BACKGROUND
  The impact of restoring sinus rhythm (SR) by initial ablation in patients with long-standing persistent atrial fibrillation (LSPAF) is not fully established.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the prognostic value of SR restoration at the initial procedure and arrhythmia noninducibility at the final repeat procedure for long-term outcome.
  
  
  METHODS
  A total of 203 patients (22% female; age 59 ± 9 years) underwent stepwise catheter ablation for LSPAF.
  
  
  RESULTS
  The procedural end-point of SR restoration was achieved in 50% of patients. During follow-up (median 48 months) and after 1.7 procedures per patient, 72% of patients were free from arrhythmia off antiarrhythmic drugs. Failure to restore SR was independently predicted by left atrial (LA) long-axis diameter ≥68 mm (relative risk [RR] 1.55, P = .03], proportion of high-voltage LA sites <20% (RR 1.62, P = .02), and left atrial appendage (LAA) atrial fibrillation cycle length (AFCL) <155 ms (RR 1.5, P = .05). Arrhythmia recurrence after the initial procedure was predicted by SR nonrestoration (RR 2.99, P <.000001) and LAA AFCL ≥155 ms (RR 1.90, P = .0002). Arrhythmia recurrence after the final procedure was predicted by SR nonrestoration at the initial procedure (RR 2.83, P = .0007), persistent AF duration ≥24 months (RR 2.74, P = .002), LAA outflow velocity <40 cm/s (RR 2.21, P = .006), and LAA AFCL ≥155 ms (RR 1.92, P = .02). In 115 patients with repeat procedure(s), failure to achieve arrhythmia noninducibility at the final procedure (19% of patients) was associated with arrhythmia recurrence (RR 8.9, P < .000001).
  
  
  CONCLUSIONS
  SR restoration at the initial procedure and arrhythmia noninducibility at the last repeat procedure were major predictors of arrhythmia-free outcome after ablation for LSPAF.
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital, Brno, Czech Republic; Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic. Electronic address: martin.fiala@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Fiala
authors.affiliation: Department of Cardiology and Angiology, St. Anne's University Hospital and International, Clinical Research Center, Brno, Czech Republic.
authors.forename: Veronika
authors.initials: V
authors.lastname: Bulková
authors.affiliation: Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic.
authors.forename: Libor
authors.initials: L
authors.lastname: Škňouřil
authors.affiliation: Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic.
authors.forename: Renáta
authors.initials: R
authors.lastname: Nevřalová
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital, Brno, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Toman
authors.affiliation: Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Januška
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital, Brno, Czech Republic.
authors.forename: Jindřich
authors.initials: J
authors.lastname: Špinar
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Dan
authors.initials: D
authors.lastname: Wichterle
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D018153:Czech Republic / Q000453:epidemiology; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D013995:Time; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Long-standing persistent atrial fibrillation; Noninducibility; Outcome; Sinus rhythm restoration