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. 2009 Apr 1;1(6):161.
doi: 10.4022/jafib.161. eCollection 2009 Apr-May.

Predictors of Success After a First Circumferential Pulmonary Vein Isolation For Atrial Fibrillation

T De Potter  1 , R Tavernier  1 , D Devos  1 , K Van Beeumen  1 , M Duytschaever  1
Affiliations

Predictors of Success After a First Circumferential Pulmonary Vein Isolation For Atrial Fibrillation

T De Potter et al. J Atr Fibrillation. .

Abstract

Background: To identify and characterise pre-procedural and procedural parameters which predict maintenance of sinus rhythm after a first circumferential pulmonary vein isolation (CPVI) for recurrent atrial fibrillation (AF). Methods: 100 patients (54±10 yrs) undergoing CARTO-guided CPVI for symptomatic drug refractory, paroxysmal or shortstanding persistent AF were studied. The endpoint was complete electrical isolation within the encircled regions. 3D left atrial (LA) volume was measured by CARTO geometry. Follow-up examinations (symptoms, ECG, 24-hour ECG recording) were performed at 1 and 3 months and every 3 months thereafter. Results: After the first CPVI, 71 patients (71%) were free of AF without antiarrhythmic drug therapy (follow up:28±11 months). The only independent and significant predictors for freedom of AF after the first CPVI were duration of AF history and 3D LA volume (p<0.05). However, a significant overlap in durations of AF history and 3D LA volumes between failures and successes was observed. Conclusions: (1) Using the "circumferential pulmonary vein isolation" approach, the first catheter ablation leads to resolution of arrhythmia in ≈ 70% of symptomatic AF patients. (2) Independent predictors for freedom of AF after initial CPVI are duration of AF history and 3D LA volume. (3) Due to considerable overlap between failures and successes, these parameters can not be used to identify patients who should not undergo CPVI or in whom an additional ablation beyond CPVI is required. On the other hand, our results do suggest that an ablation strategy early in the course of AF disease can influence successful outcome.

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Figures

Figure 1.
Figure 1.. Left panel: Carto-guided PV encircling (PA view). Right panel: example of PV isolation recorded by circular mapping catheter
Figure 2.
Figure 2.. Duration of AF history and 3D LA volume (Carto) compared between failed and successful CPVI procedures. p < 0.05 for both comparisons
Figure 3.
Figure 3.. ROC-curves for duration of AF history and LA volume suggesting a low overall diagnostic accuracy of these predictors
See this image and copyright information in PMC

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