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Background: Catheter ablation can restore sinus rhythm in selected patients with atrial fibrillation (AF), but its preventive function for thromboembolic events (TE) is still underdetermined., Methods: We retrospectively studied 520 consecutive patients with AF who were referred for circumferential pulmonary vein ablation. The incidence of late TE was investigated, and the predictors of late TE were identified from analysis of the basic clinical variables of patients with late TE., Results: Eight (1.5%) patients experienced late TE during 28+/-8 months follow-up. When TE occurred, most (6/8, 75%) patients were documented with recurrence episode. The recurrence of AF was more frequent in patients with late TE than patients without late TE (75.0% vs 30.5%, P=0.007). Multivariate logistic regression analysis identified that all risk factors, including all clinical variants prior ablation and the CHADS2 score, were not related to late TE but the presence of recurrence was the only predictor of late TE (odds ratio, 5.542; 95% confidence interval [1.416-45.013], P=0.019)., Conclusions: Our study demonstrates a strong relationship between the recurrence after ablation and TE post-operation and supports the proposal that free of recurrence is an indication for discontinuation of anticoagulation after ablation.

Introduction: The reliability of delayed cure of early recurrence of atrial fibrillation (ERAF) is still undetermined. Furthermore, the predictors of recurrence after delayed cure of ERAF are less investigated in depth., Aims of the Study: The purpose of this study was to investigate the long-term efficacy of delayed cure of ERAF after catheter ablation of AF and explore the he predictors of recurrence after delayed cure of ERAF., Methods and Results: We prospectively studied 300 consecutive patients with atrial fibrillation (AF) who were referred for circumferential pulmonary vein ablation (CPVA). After a follow-up of 19.2 +/- 4.1months, of the 87 patients with early recurrence of AF 41 achieved delayed cure, 11 of them reoccurred AF subsequently. Univariate analysis showed that persistent AF, absence of pulmonary vein (PV) isolation and external cardioversion were related to reoccurrence after delayed cure. Logistic regression analysis identified only absence of PV isolation as a predictor of recurrent AF after delayed cure., Conclusions: Delayed cure after CPVA is relatively common and its efficacy at long-term follow-up is reasonably consistent. However, in patients without PV isolation, delayed cure is unstable and the risk of late recurrence is increased.

Background: Early recurrence of atrial fibrillation (ERAF) after catheter ablation is common and has been thoroughly studied. However, very late recurrence of atrial fibrillation (VLRAF) is rarely researched, and its characteristics have not been determined., Hypothesis: The aim of this study was to investigate the clinical characteristics of VLRAF after circumferential pulmonary vein ablation (CPVA), and to identify the risk factors for VLRAF., Methods: We retrospectively studied 259 consecutive patients with atrial fibrillation (AF) who were referred for CPVA. Clinical variables were investigated and predictors of VLRAF were identified., Results: A total of 249 patients were enrolled in this study. After a mean follow-up of 18.2 +/- 4.4 mo, 14 patients (5.6%) had VLRAF. Patients with VLRAF were more likely than those without recurrence to have ERAF (78.6% versus 17.8%, p = 0.000) and persistent AF (50.0% versus 13.0%, p = 0.000), but were less likely to achieve pulmonary vein (PV) isolation (78.6% versus 97.6%, p = 0.000). Bivariate analysis demonstrated that ERAF (odds ratio [OR] 8.148, 95% confidence interval [CI] 2.197-30.222; p = 0.002), persistent AF (OR 8.853, 95% CI 1.773-16.155; p = 0.003), and lack of PV isolation (OR 7.530, 95% CI 1.792-33.122; p = 0.006) were related to VLRAF. Multivariate logistic regression analysis only identified ERAF as a predictor of VLRAF after CPVA (OR 7.461, 95% CI 1.696-24.836; p = 0.006)., Conclusions: Very late recurrence of AF is uncommon after CPVA. That occurs more commonly in patients with ERAF., (Copyright (c) 2008 Wiley Periodicals, Inc.)

Summary: Complex fragment atrial electrograms (CFAEs) are fractionated or discrete atrial wave fronts that frequently mapped in chronic atrial fibrillation (CAF). The CFAEs areas represent slow conduction and/or functional blocks that play substrate role in AF. Compared with the limited efficacy of pulmonary veins (PVs) oriented ablation strategy for CAF, few attempts of adjunctive ablation on CFAEs gain promising outcome. We hypothesized that CFAEs, not PVs, are the ideal ablation targets for CAF. [Copyright &y& Elsevier]