title: Long-term outcome after catheter ablation of paroxysmal atrial fibrillation: Impact of different atrial fibrillation foci.
abstract: BACKGROUND
  We aimed to determine whether differing foci in paroxysmal atrial fibrillation (PAF) affected the long-term outcome of catheter ablation (CA).
  
  
  METHODS
  A total of 865 consecutive PAF patients (age, 61±10years; 670 male) undergoing initial AF ablation were included. After pulmonary vein (PV) isolation, superior vena cava (SVC) isolation was performed for SVC foci; other non-PV foci were focally ablated. Long-term outcomes were compared among patients with SVC foci (Group SVC), other non-PV foci (Group Non-PV), and those without these foci (Group PV).
  
  
  RESULTS
  Groups PV, SVC, and Non-PV contained 740 (85.8%), 57 (6.6%), and 68 (7.6%) patients, respectively. Structural heart disease (P=0.01) and duration of AF history (P=0.04) were significantly associated with Group Non-PV, and female sex (P=0.0002) was significantly associated with Group SVC. AF recurrence-free rates at 5years in Group PV, SVC, and Non-PV were 62.0%, 66.3%, and 49.3%, respectively (P=0.03), after the initial CA, and 84.7%, 83.9%, and 77.0%, respectively (P=0.02), after the final CA. The duration of AF history (HR, 1.04, P<0.0001) and left atrial dimension (HR, 1.37 per 10mm increase, P=0.0003) were significant predictors of AF recurrence after the initial CA. Although Group Non-PV was weakly associated (HR 1.38, P=0.08) with AF recurrence, Group SVC was not associated with AF recurrence.
  
  
  CONCLUSIONS
  Long-term outcome of CA of PAF was significantly worse in patients with non-PV foci other than SVC foci. These foci may affect the outcome not independently but as an aspect of atrial remodeling.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: teru.takigawa@gmail.com.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watari
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Emiko
authors.initials: E
authors.lastname: Nakashima
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fujino
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior
keywords: Atrial fibrillation; Catheter ablation; Long-term outcome; Non-PV foci; SVC