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

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.