title: Primary Persistent Atrial Fibrillation: A Distinct Arrhythmia Subentity of an Ablation Population.
abstract: BACKGROUND
  Persistent atrial fibrillation (persAF) can occur either as a sustained arrhythmia that has progressed from initially paroxysmal AF or as primary persAF without a history of any spontaneously terminated episode. There is a paucity of data differentiating between the 2 different persAF entities. Thus, we prospectively evaluated baseline characteristics, electrophysiological features, and ablation outcome in these 2 patient cohorts.
  
  
  RESULTS
  A total number of 154 consecutive persAF patients (63 ± 10 years, f = 42, longstanding persAF = 60) were characterized in terms of having primary persAF (P-persAF group) or persAF that secondarily progressed from paroxysmal AF (S-persAF group). All patients underwent de novo catheter ablation using the stepwise approach. PersAF entities were characterized by detailed patient history, sequential Holter monitoring, and reports of documented modes of AF conversion, respectively. The P-persAF group had a higher number of young patients (<50 years), a shorter AF history, and a higher number of congestive heart failure. The HATCH score did not differ between the groups. Procedural AF termination rate was significantly higher in S-persAF than in P-persAF patients (n = 55 [81%] vs. n = 58 [68%], P = 0.043). At 1-year follow-up, the arrhythmia-free survival after a single procedure was significantly lower in patients with P-persAF (26% vs. 43%, P = 0.016). Categorization to P-persAF was the strongest independent predictor of arrhythmia recurrence.
  
  
  CONCLUSIONS
  P-persAF seems to be a specific arrhythmia entity that is associated with a lower AF-termination rate and a worse outcome after catheter ablation as compared to S-persAF.
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Torsten
authors: T
authors: Konrad
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Cathrin
authors: C
authors: Theis
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Hanke
authors: H
authors: Mollnau
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Sebastian
authors: S
authors: Sonnenschein
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Blanca Quesada
authors: BQ
authors: Ocete
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Karsten
authors: K
authors: Bock
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Thomas
authors: T
authors: Münzel
authors: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors: Thomas
authors: T
authors: Rostock
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000145:classification / Q000503:physiopathology* / Q000628:therapy*; D017115:Catheter Ablation; D015331:Cohort Studies; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D055724:Electrophysiological Phenomena; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; left atrium; paroxysmal atrial fibrillation; persistent atrial fibrillation