Long-term outcome after catheter ablation of paroxysmal atrial fibrillation: Impact of different atrial fibrillation foci

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• 作者：Masateru Takigawa^a ; ^b ; ^c ; ^{teru.takigawa@gmail.com} ; Atsushi Takahashi^a ; Taishi Kuwahara^a ; Kenji Okubo^a ; Yoshihide Takahashi^a ; Yuji Watari^a ; Emiko Nakashima^a ; Jun Nakajima^a ; Kazuya Yamao^a ; Katsumasa Takagi^a ; Yasuaki Tanaka^a ; Tadashi Fujino^a ; Shigeki Kimura^a ; Hiroyuki Hikita^a ; Kenzo Hirao^b ; Mitsuaki Isobe^c
• 关键词：Atrial fibrillation ; Catheter ablation ; Long-term outcome ; SVC ; Non-PV foci
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：407-412
• 全文大小：704 K
• 卷排序：227

文摘

We aimed to determine whether differing foci in paroxysmal atrial fibrillation (PAF) affected the long-term outcome of catheter ablation (CA).MethodsA total of 865 consecutive PAF patients (age, 61&#xA0;± 10 years; 670 male) undergoing initial AF ablation were included. After pulmonary vein (PV) isolation, superior vena cava (SVC) isolation was performed for SVC foci; other non-PV foci were focally ablated. Long-term outcomes were compared among patients with SVC foci (Group SVC), other non-PV foci (Group Non-PV), and those without these foci (Group PV).ResultsGroups PV, SVC, and Non-PV contained 740 (85.8%), 57 (6.6%), and 68 (7.6%) patients, respectively. Structural heart disease (P = 0.01) and duration of AF history (P = 0.04) were significantly associated with Group Non-PV, and female sex (P = 0.0002) was significantly associated with Group SVC. AF recurrence-free rates at 5 years in Group PV, SVC, and Non-PV were 62.0%, 66.3%, and 49.3%, respectively (P = 0.03), after the initial CA, and 84.7%, 83.9%, and 77.0%, respectively (P = 0.02), after the final CA. The duration of AF history (HR, 1.04, P < 0.0001) and left atrial dimension (HR, 1.37 per 10 mm increase, P = 0.0003) were significant predictors of AF recurrence after the initial CA. Although Group Non-PV was weakly associated (HR 1.38, P = 0.08) with AF recurrence, Group SVC was not associated with AF recurrence.ConclusionsLong-term outcome of CA of PAF was significantly worse in patients with non-PV foci other than SVC foci. These foci may affect the outcome not independently but as an aspect of atrial remodeling.