title: Impact of acute atrial fibrillation termination and prolongation of atrial fibrillation cycle length on the outcome of ablation of persistent atrial fibrillation: A substudy of the STAR AF II trial.
abstract: Controversy exists about the impact of acute atrial fibrillation (AF) termination and prolongation of atrial fibrillation cycle length (AFCL) during ablation on long-term procedural outcome.
  
  
  
  The purpose of this study was to analyze the influence of AF termination and AFCL prolongation on freedom from AF in patients from the STAR AF II (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial-Part II) trial.
  
  
  
  Acute changes in AFCL and AF termination were collected during the index procedure of the STAR AF II trial and compared to recurrence of AF at 18 months. Recurrence was assessed by ECG, Holter (3, 6, 9, 12, 18 months), and weekly transtelephonic ECG monitoring for 18 months.
  
  
  
  AF terminated in 8% of the pulmonary vein isolation (PVI) arm, 45% in the PVI+complex electrogram arm, and 22% of the PVI+linear ablation arm (P <.001), but freedom from AF did not differ among the 3 groups (P = .15). Freedom from AF was significantly higher in patients who presented to the laboratory in sinus rhythm (SR) compared to those without AF termination (63% vs 44%, P = .007). Patients with AF termination had an intermediate outcome (53%) that was not significantly different from those in SR (P = .84) or those who did not terminate (P = .08). AF termination was a univariable predictor of success (P = .007), but by multivariable analysis, presence of early SR was the strongest predictor of success (hazard ratio 0.67, P = .004). Prolongation of AFCL was not predictive of 18-month freedom from AF.
  
  
  
  Acute AF termination and prolongation in AFCL did not consistently predict 18-month freedom from AF. Presence of SR before or early during the ablation was the strongest predictor of better outcome.
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada; Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Muenster, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Kochhäuser
authors.affiliation: Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
authors.forename: Chen-Yang
authors.initials: CY
authors.lastname: Jiang
authors.affiliation: Department of Cardiology, Oxford University Hospitals, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Betts
authors.affiliation: Haukeland University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.affiliation: Deutsches Herzzentrum München, Munich, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.affiliation: Ospedale S. Maria di Ca' Foncelli, Treviso, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mantovan
authors.affiliation: Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.affiliation: Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morillo
authors.affiliation: Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.affiliation: Department of Cardiology, Hollywood Private Hospital, Nedlands, Western Australia, Australia, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.affiliation: Département de Rythmologie, Clinic Pasteur of Toulouse, Toulouse, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Albenque
authors.affiliation: Pineta Grande Hospital, Castel Volturno, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nardi
authors.affiliation: Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
authors.forename: Endrj
authors.initials: E
authors.lastname: Menardi
authors.affiliation: Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Novak
authors.affiliation: Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada. Electronic address: atul.verma@utoronto.ca.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ablation; Atrial fibrillation; Atrial fibrillation cycle length; Outcome; Termination