title: Atrial ectopy predicts late recurrence of atrial fibrillation after pulmonary vein isolation.
abstract: BACKGROUND
  Late recurrence of atrial fibrillation (AF) after radiofrequency ablation remains significant. Asymptomatic recurrence poses a difficult clinical problem as it is associated with an equally increased risk of stroke and death compared with symptomatic AF events. Meta-analyses reveal that no single preablation patient characteristic efficiently predicts these AF recurrences. This study aimed to evaluate the prognostic value of premature atrial complex (PAC) occurrence with regard to the risk of late AF recurrence after radiofrequency ablation.
  
  
  RESULTS
  The study cohort consisted of 124 patients with 7-day Holter recordings at 6 months post radiofrequency ablation for AF. No patients had AF recurrence before this time. Patients were followed-up every 6 months. Holter-detected PACs were defined as any supraventricular complexes occurring >30% earlier than expected. During a median follow-up of 4.2 years (first quartile to third quartile [Q1-Q3]=1.6-4.5), 32 patients (26%) had late recurrences of AF at a median of 462 days (Q1-Q3=319-1026) post radiofrequency ablation. The number of PACs per 24 hours was 248 (Q1-Q3=62-1026) in patients with and 77 (Q1-Q3=24-448) in patients without recurrence of AF (P=0.02). Multivariate analysis of the risk of late AF recurrence found ≥142 PACs per 24 hours to have a hazard ratio 2.84 (confidence interval, 1.26-6.43), P=0.01.
  
  
  CONCLUSIONS
  This study showed that occurrence of ≥142 PACs per day at 6 months after PVI was independently associated with a significantly increased risk of late AF recurrence. These results could have important clinical implications for the design of post-PVI follow-up.
  
  
  BACKGROUND
  URL: http://www.anzctr.org.au. Unique identifier: ACRTN12606000467538.
authors.affiliation: From the Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (U.J.O.G.); and Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia (C.J.N., T.W.L., A.T., P.K., D.L.R., S.P.T.). dr.gang@dadlnet.dk.
authors.forename: Uffe J O
authors.initials: UJ
authors.lastname: Gang
authors.affiliation: From the Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (U.J.O.G.); and Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia (C.J.N., T.W.L., A.T., P.K., D.L.R., S.P.T.).
authors.forename: Chrishan J
authors.initials: CJ
authors.lastname: Nalliah
authors.affiliation: From the Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (U.J.O.G.); and Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia (C.J.N., T.W.L., A.T., P.K., D.L.R., S.P.T.).
authors.forename: Toon Wei
authors.initials: TW
authors.lastname: Lim
authors.affiliation: From the Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (U.J.O.G.); and Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia (C.J.N., T.W.L., A.T., P.K., D.L.R., S.P.T.).
authors.forename: Aravinda
authors.initials: A
authors.lastname: Thiagalingam
authors.affiliation: From the Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (U.J.O.G.); and Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia (C.J.N., T.W.L., A.T., P.K., D.L.R., S.P.T.).
authors.forename: Pramesh
authors.initials: P
authors.lastname: Kovoor
authors.affiliation: From the Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (U.J.O.G.); and Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia (C.J.N., T.W.L., A.T., P.K., D.L.R., S.P.T.).
authors.forename: David L
authors.initials: DL
authors.lastname: Ross
authors.affiliation: From the Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (U.J.O.G.); and Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia (C.J.N., T.W.L., A.T., P.K., D.L.R., S.P.T.).
authors.forename: Stuart P
authors.initials: SP
authors.lastname: Thomas
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018880:Atrial Premature Complexes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; post-PVI recurrence of atrial fibrillation; premature atrial complexes; pulmonary vein isolation; radiofrequency ablation