title: Early pulmonary vein reconnection as a predictor of left atrial ablation outcomes for paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  The objective of the study was to investigate whether early pulmonary vein reconnection (PVR) is a predictor of late arrhythmia recurrence after a single ablation procedure for paroxysmal atrial fibrillation (AF). Further ablation was delivered to patients with acute PVR to test whether this strategy could reduce recurrences.
  
  
  RESULTS
  One hundred and forty-four consecutive patients with symptomatic, drug-refractory paroxysmal AF, undergoing pulmonary vein isolation (PVI), were assigned to the 'PVR30 test' group, where PVR was monitored for 30 min after initial PVI and further ablation was applied if needed, and compared with a control group of 128 patients, where the procedure was terminated after initial successful isolation. During a mean follow-up of 17.7 months, sinus rhythm was maintained in 101 patients in the 'PVR30 test' group (70.1%) vs. 78 in the control group (60.9%) (P = 0.13). Among patients with acute PVR and reablation after 30 min, the recurrence rate was 45.3 vs. 39.1% in the control group (P = 0.47). Multivariable logistic regression analysis showed that PVR was independently associated with AF recurrence (adjusted hazard ratio 4.7, 95% confidence interval 1.8-12.2), along with left atrial diameter (adjusted hazard ratio 1.3/mm of higher diameter, 95% confidence interval 1.2-1.4).
  
  
  CONCLUSIONS
  In patients with paroxysmal AF undergoing a single ablation procedure, PVR 30 min after the initial PVI is associated with late AF recurrence. However, the strategy of 30 min waiting and reablating does not appear to be superior to immediate termination of the procedure after initial PVI.
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Michael
authors: M
authors: Efremidis
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Konstantinos
authors: K
authors: Letsas
authors: Department of Cardiology, Athens General Hospital 'G. Gennimatas', Athens, Greece Hellenic Center for Disease Control and Prevention, Athens, Greece ggiann@med.uoa.gr georgios.giannopolous@yale.edu.
authors: Georgios
authors: G
authors: Giannopoulos
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Louisa
authors: L
authors: Lioni
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Konstantinos
authors: K
authors: Vlachos
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Dimitrios
authors: D
authors: Asvestas
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Dimitrios
authors: D
authors: Karlis
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Vasileios
authors: V
authors: Kareliotis
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Hrysoula
authors: H
authors: Geladari
authors: Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece.
authors: Antonios
authors: A
authors: Sideris
authors: Department of Cardiology, Athens General Hospital 'G. Gennimatas', Athens, Greece.
authors: Spyridon
authors: S
authors: Deftereos
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Antral; Atrial fibrillation; Catheter ablation; Isolation; Pulmonary vein reconnection