1. Predictors of successful complex catheter ablation for persistent atrial fibrillation despite failure of targeted procedural arrhythmia termination.
- Author
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Spittler R, Bahlke F, Hoffmann BA, Theis C, Mollnau H, Marx A, Ocete BQ, Ilioska P, Lange B, Konrad T, and Rostock T
- Subjects
- Action Potentials, Aged, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation physiopathology, Atrial Function, Left, Female, Heart Rate, Humans, Male, Middle Aged, Progression-Free Survival, Recurrence, Risk Factors, Tachycardia, Supraventricular etiology, Tachycardia, Supraventricular physiopathology, Time Factors, Atrial Fibrillation surgery, Catheter Ablation adverse effects
- Abstract
Introduction: Procedural atrial fibrillation (AF) termination is considered as a predictor of long-term success after catheter ablation for persistent AF (persAF). However, some patients remain free of arrhythmia recurrences despite failure to achieve AF termination. The objective of this study was to assess long-term outcome and prognostic factors in patients undergoing complex ablation without procedural AF termination., Methods and Results: This study comprised 419 patients (63.8 ± 10.2 years, 63.4% male) undergoing complex ablation for persAF. Patients without procedural AF termination (n = 137, 64.2 ± 9.7 years, 63.5% male) were categorized into patients who remained in sinus rhythm (SR) in long-term outcome (SR-group) and patients with recurrence of AF or atrial tachycardia (AT) (AR-group). During a follow-up (FU) of 19.6 ± 14.6 months, the SR-group consisted of 65 (47.5%) and the AR-group of 69 (50.4%) patients. Three patients (2.2%) were lost to FU. Left atrial appendage (LAA) flow velocity and left atrium volume index (LAVI) could be identified as predictors for long-term success. LAA flow velocity and baseline AF cycle length (AFCL) were significantly associated with the type of arrhythmia recurrence (AF vs AT), ie, higher values of both are predictive for AT rather than AF recurrences. Patients with a LAVI < 34.4 mL/m² and significant AFCL increase during the ablation procedure had rather AT than AF recurrences., Conclusion: Patients with an arrhythmia-free outcome despite failure of procedural AF termination during complex ablation for persAF are characterized by specific morphological and functional properties that are easy to obtain., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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