title: Radiofrequency Ablation of Persistent Atrial Fibrillation: Diagnosis-to-Ablation Time, Markers of Pathways of Atrial Remodeling, and Outcomes.
abstract: BACKGROUND
  Various ablation strategies of persistent atrial fibrillation (PersAF) have had disappointing outcomes, despite concerted clinical and research efforts, which could reflect progressive atrial fibrillation-related atrial remodeling.
  
  
  RESULTS
  Two-year outcomes were assessed in 1241 consecutive patients undergoing first-time ablation of PersAF (2005-2012). The time intervals between the first diagnosis of PersAF and the ablation procedures were determined. Patients had echocardiograms and measures of B-type natriuretic peptide and C-reactive protein before the procedures. The median diagnosis-to-ablation time was 3 years (25th-75th percentiles 1-6.5). With longer diagnosis-to-ablation time (based on quartiles), there was a significant increase in recurrence rates in addition to an increase in B-type natriuretic peptide levels (P=0.01), C-reactive protein levels (P<0.0001), and left atrial size (P=0.03). The arrhythmia recurrence rates over 2 years were 33.6%, 52.6%, 57.1%, and 54.6% in the first, second, third, and fourth quartiles, respectively (P(categorical)<0.0001). In Cox Proportional Hazard analyses, B-type natriuretic peptide levels, C-reactive protein levels, and left atrial size were associated with arrhythmia recurrence. The diagnosis-to-ablation time had the strongest association with the ablation outcomes which persisted in multivariable Cox analyzes (hazard ratio for recurrence per +1Log diagnosis-to-ablation time 1.27, 95% confidence interval 1.14-1.43; P<0.0001; hazard ratio fourth versus first quartile 2.44, 95% confidence interval 1.68-3.65; P(categorical)<0.0001).
  
  
  CONCLUSIONS
  In patients with PersAF undergoing ablation, the time interval between the first diagnosis of PersAF and the catheter ablation procedure had a strong association with the ablation outcomes, such as shorter diagnosis-to-ablation times were associated with better outcomes and in direct association with markers of atrial remodeling.
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Amr
authors.initials: A
authors.lastname: Barakat
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Mohammed
authors.initials: M
authors.lastname: Bassiouny
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Mohammed
authors.initials: M
authors.lastname: Chamsi-Pasha
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Rasha
authors.initials: R
authors.lastname: Al-Bawardy
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Ali
authors.initials: A
authors.lastname: Hakim
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Tarakji
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Cantillon
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Dresing
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Niraj
authors.initials: N
authors.lastname: Varma
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Callahan
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Mark
authors.initials: M
authors.lastname: Niebauer
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kanj
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Mina
authors.initials: M
authors.lastname: Chung
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Lindsay
authors.affiliation: From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.). waznio@ccf.org.
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D064752:Atrial Remodeling / Q000502:physiology*; D015415:Biomarkers / Q000097:blood*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers
keywords: ablation; atrial fibrillation; catheter ablation; outcome; outcomes research