Abstract
Background
Early recurrence of atrial fibrillation (ERAF) after catheter ablation is common and has been thoroughly studied. However, very late recurrence of atrial fibrillation (VLRAF) is rarely researched, and its characteristics have not been determined.
Hypothesis
The aim of this study was to investigate the clinical characteristics of VLRAF after circumferential pulmonary vein ablation (CPVA), and to identify the risk factors for VLRAF.
Methods
We retrospectively studied 259 consecutive patients with atrial fibrillation (AF) who were referred for CPVA. Clinical variables were investigated and predictors of VLRAF were identified.
Results
A total of 249 patients were enrolled in this study. After a mean follow‐up of 18.2 ± 4.4 mo, 14 patients (5.6%) had VLRAF. Patients with VLRAF were more likely than those without recurrence to have ERAF (78.6% versus 17.8%, p = 0.000) and persistent AF (50.0% versus 13.0%, p = 0.000), but were less likely to achieve pulmonary vein (PV) isolation (78.6% versus 97.6%, p = 0.000). Bivariate analysis demonstrated that ERAF (odds ratio [OR] 8.148, 95% confidence interval [CI] 2.197–30.222; p = 0.002), persistent AF (OR 8.853, 95% CI 1.773–16.155; p = 0.003), and lack of PV isolation (OR 7.530, 95% CI 1.792–33.122; p = 0.006) were related to VLRAF. Multivariate logistic regression analysis only identified ERAF as a predictor of VLRAF after CPVA (OR 7.461, 95% CI 1.696–24.836; p = 0.006).
Conclusions
Very late recurrence of AF is uncommon after CPVA. That occurs more commonly in patients with ERAF. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: recurrence, ablation, atrial fibrillation
Full Text
The Full Text of this article is available as a PDF (250.2 KB).
REFERENCES
- 1. Haissaguerre M, Jais P, Shah DC, Gencel L, Pradeau V, et al.: Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 1996; 7: 1132–1144. [DOI] [PubMed] [Google Scholar]
- 2. Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, et al.: Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002; 105: 1077–1081. [DOI] [PubMed] [Google Scholar]
- 3. Oral H, Scharf C, Chugh A, Hall B, Cheung P, et al.: Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003; 108: 2355–2360. [DOI] [PubMed] [Google Scholar]
- 4. Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, et al.: Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation 2000; 102: 2619–2628. [DOI] [PubMed] [Google Scholar]
- 5. Oral H, Knight BP, Ozaydin M, Tada H, Chugh A, et al.: Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. J Am Coll Cardiol 2002; 40: 100–104. [DOI] [PubMed] [Google Scholar]
- 6. O'Donnell D, Furniss SS, Dunuwille A, Bourke JP: Delayed cure despite early recurrence after pulmonary vein isolation for atrial fibrillation. Am J Cardiol 2003; 91: 83–85. [DOI] [PubMed] [Google Scholar]
- 7. Ouyang F, Bansch D, Ernst S, Schaumann A, Hachiya H, et al.: Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double‐Lasso technique in paroxysmal atrial fibrillation. Circulation 2004; 110: 2090–2096. [DOI] [PubMed] [Google Scholar]
- 8. Liu X, Dong J, Mavrakis HE, Hu F, Long D, et al.: Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: a randomized comparison between two different isolation approaches. J Cardiovasc Electrophysiol 2006; 17: 1263–1270. [DOI] [PubMed] [Google Scholar]
- 9. Hsieh MH, Tai CT, Tsai CF, Lin WS, Lin YK, et al.: Clinical outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2003; 14: 598–601. [DOI] [PubMed] [Google Scholar]
- 10. Hsieh MH, Tai CT, Lee SH, Lin YK, Tsao HM, et al.: The different mechanisms between late and very late recurrences of atrial fibrillation in patients undergoing a repeated catheter ablation. J Cardiovasc Electrophysiol 2006; 17: 231–235. [DOI] [PubMed] [Google Scholar]
- 11. Mainigi SK, Sauer WH, Cooper JM, Dixit S, Gerstenfeld EP, et al.: Incidence and predictors of very late recurrence of atrial fibrillation after ablation. J Cardiovasc Electrophysiol 2007; 18: 69–74. [DOI] [PubMed] [Google Scholar]
- 12. Saito T, Waki K, Becker AE: Left atrial myocardial extension onto pulmonary veins in humans: anatomic observations relevant for atrial arrhythmias. J Cardiovasc Electrophysiol 2000; 11: 888–894. [DOI] [PubMed] [Google Scholar]
- 13. Kholova I, Kautzner J: Morphology of atrial myocardial extensions into human caval veins: a postmortem study in patients with and without atrial fibrillation. Circulation 2004; 110: 483–488. [DOI] [PubMed] [Google Scholar]
- 14. Lee SH, Tai CT, Hsieh MH, Tsai CF, Lin YK, et al.: Predictors of early and late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2004; 10: 221–226. [DOI] [PubMed] [Google Scholar]
- 15. Nanthakumar K, Plumb VJ, Epstein AE, Veenhuyzen GD, Link D, et al.: Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation 2004; 109: 1226–1229. [DOI] [PubMed] [Google Scholar]
- 16. Lemola K, Hall B, Cheung P, Good E, Han J, et al.: Mechanisms of recurrent atrial fibrillation after pulmonary vein isolation by segmental ostial ablation. Heart Rhythm 2004; 1: 197–202. [DOI] [PubMed] [Google Scholar]
- 17. Cheema A, Dong J, Dalal D, Marine JE, Henrikson CA, et al.: Incidence and time course of early recovery of pulmonary vein conduction after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2007; 18: 387–391. [DOI] [PubMed] [Google Scholar]
- 18. Chang SH, Tsao HM, Wu MH, Tai CT, Chang SL, et al.: Morphological changes of the left atrial appendage after catheter‐ ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2007; 18: 47–52. [DOI] [PubMed] [Google Scholar]