title: Atrial Fibrillation Complexity Parameters Derived From Surface ECGs Predict Procedural Outcome and Long-Term Follow-Up of Stepwise Catheter Ablation for Atrial Fibrillation.
abstract: BACKGROUND
  The success rate of catheter ablation for persistent atrial fibrillation (AF) is still far from satisfactory. Identification of patients who will benefit from ablation is highly desirable. We investigated the predictive value of noninvasive AF complexity parameters derived from standard 12-lead ECGs for AF termination and long-term success of catheter ablation and compared them with clinical predictors.
  
  
  RESULTS
  The study included a training (93 patients) and a validation set (81 patients) of patients with persistent AF undergoing stepwise radiofrequency ablation. In the training set AF terminated in 81% during catheter ablation, 77% were in sinus rhythm after 6 years and multiple ablations. ECG-derived complexity parameters were determined from a baseline 10-s 12-lead ECG. Prediction of AF termination was similar using only ECG (cross-validated mean area under the curve [AUC], 0.76±0.15) or only clinical parameters (mean AUC, 0.75±0.16). The combination improved prediction to a mean AUC of 0.79±0.13. Using a combined model of ECG and clinical parameters, sinus rhythm at long-term follow-up could be predicted with a mean AUC of 0.71±0.12. In the validation set AF terminated in 57%, 61% were in sinus rhythm after 4.6 years. The combined models predicted termination with an AUC of 0.70 and sinus rhythm at long-term follow-up with an AUC of 0.61. Overall, fibrillation-wave amplitude provided the best rhythm prediction.
  
  
  CONCLUSIONS
  The predictive performance of ECG-derived AF complexity parameters for AF termination and long-term success of catheter ablation in patients with persistent AF is at least as good as known clinical predictive parameters, with fibrillation-wave amplitude as the best predictor.
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Theo
authors.initials: T
authors.lastname: Lankveld
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Stef
authors.initials: S
authors.lastname: Zeemering
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherr
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Pawel
authors.initials: P
authors.lastname: Kuklik
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.).
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Crijns
authors.affiliation: From the Departments of Cardiology (T.L., H.J.C.) and Physiology (T.L., S.Z., P.K., U.S.), Maastricht University Medical Centre, Maastricht, the Netherlands; Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria (D.S., B.P.); Department Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.K., B.A.H., S.W.); and Department of Cardiology, Hôpital Cardiologique du Haut Lévêque, Université Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux, France (M.H., P.J.). schotten@maastrichtuniversity.nl.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schotten
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D012086:Reoperation; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; electrocardiography; follow-up studies; heart atria