- 作者：Kohki Nakamura ; Shigeto Naito ; Kenichi Kaseno ; Naofumi Tsukada ; Takehito Sasaki ; Mamoru Hayano ; Suguru Nishiuchi ; Etsuko Fuke ; Yuko Miki ; Tamotsu Sakamoto ; Keijiro Nakamura ; Koji Kumagai ; Akihisa Kataoka ; Hiroyuki Takaoka ; Yoshio Kobayashi ; Nobusada Funabashi ; Shigeru Oshima
- 关键词：Optimal observation time ; Circumferential pulmonary vein isolation ; Atrial fibrillation ; Chronic pulmonary vein reconnections
- 刊名：International Journal of Cardiology
- 出版年：15 October, 2013
- 年：2013
- 卷：168
- 期：6
- 页码：5300-5310
- 全文大小：949 K
Purpose
To identify predictors of chronic pulmonary vein (PV) reconnection (CPVR) after successful circumferential PV isolation (CPVI) for atrial fibrillation (AF).Materials and methods
A total of 718 PVs from 181 consecutive AF patients (141 males, median age 61 years, 92 paroxysmal AF) who underwent a second ablation procedure for recurrent AF were retrospectively analyzed.
Results
During the second procedure, a CPVR was observed in 477 PVs (66.4%) among 169 patients. In a multiple logistic regression analysis, the observation time after the final completion of the PVI (OT-final) was a significant negative predictor (odds ratio 0.980; P < 0.001). A receiver operating characteristic analysis demonstrated that the greatest area under the curve was for the OT-final (0.670). At an optimal cutoff of 35 min, the sensitivity and specificity for predicting a CPVR were 66.9% and 60.6%, respectively. By Kaplan Meier analysis, CPVR was more frequent in PVs with an OT-final of < 35 min than 鈮?#xA0;35 min (log-rank test, P = 0.018). In a vessel-by-vessel analysis, the OT-final at all PV sites was a significant negative predictor, while male gender in the right PVs and left-inferior PV, number of RF applications for the ipsilateral CPVI in the right PVs and left-superior PV, and major PV diameter in the left-superior PV were significant positive predictors of a CPVR (all P < 0.05).
Conclusions
An optimal observation time (鈮?#xA0;35 min in this study) to determine whether PVI is successfully completed during the initial CPVI for AF may be needed to prevent a CPVR and subsequent AF recurrence thereafter.