204 consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. In all patients, a resting electrocardiogram in sinus rhythm was evaluated for the presence of advanced IAB, defined as a P-wave duration >120 ms and biphasic (±) morphology in the inferior leads. Advanced IAB was detected in 20.1% of patients. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30 s beyond 3 months after the catheter ablation in the absence of any antiarrhythmic treatment.
During the mean follow-up period of 13.9 ± 6.2 months (range, 3–27 months), 62 patients (30.4%) developed recurrence of AF. The recurrence rate was higher in patients with advanced IAB than those without advanced IAB (46.3% vs. 26.4%, p = 0.006). Cox regression analysis with adjustment for age, P-wave duration, CHADS2 score, and PV isolation identified advanced IAB (hazard ratio, 2.111; 95% confidence interval, 1.034–4.308; p = 0.040) and left atrial diameter (hazard ratio, 1.051; 95% confidence interval, 1.004–1.100; p = 0.034) as two independent predictors of recurrence of AF.
Patients with advanced IAB were at an increased risk of AF recurrence after catheter ablation.