March 23, 2007Open Access

Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=148). Intervention: Circumferential pulmonary vein ablation (CPVA). Primary outcome: Atrial fibrillation recurrence (OR 2.8 (for hypertension), 95% CI 1.5-5.4, p=0.002).

Key Result

Hypertension (OR 2.8; 95% CI 1.5-5.4) and larger left atrial diameter (OR 1.1; 95% CI 1.05-1.19) were independent pre-procedural predictors of AF recurrence after CPVA.

Study Design

Type

Observational (n=148)

PICO

Population

Atrial fibrillation (n=148)

Intervention / Comparator

Circumferential pulmonary vein ablation (CPVA)

Primary Outcome

Atrial fibrillation recurrence — OR 2.8 (for hypertension) (1.5-5.4), p=0.002

Main Result

Effect estimate: OR 2.8 (for hypertension) (95% CI 1.5-5.4)

p-value: p=0.002

Abstract

AIMS: The success rate of circumferential pulmonary vein ablation (CPVA) to treat atrial fibrillation (AF) ranges from 60 to 90%, depending on the series. The objective of the study was to identify predictors of AF recurrence after a standardized CPVA procedure. METHODS AND RESULTS: A series of 148 consecutive patients undergoing CPVA for symptomatic paroxysmal (60.8%), persistent (23.6%), or permanent (15.5%) AF refractory to antiarrhythmic drugs were included in the study. CPVA with the creation of supplementary block lines along the posterior wall and mitral isthmus was performed and a minimum of 6 months follow-up completed in all patients. Structural heart disease was present in 19.6% and hypertension in 33.8% of patients. After 13.1 +/- 8.4 months follow-up, 73.6% of patients were free of AF recurrences after a mean of 1.18 +/- 0.45 procedures/patient (one procedure in 85.2%, two procedures in 14.8%, and three procedures in 2.7%). Univariable analysis showed that the risk of AF recurrence increases with age (HR 1.03; 95% CI 1.00-1.06, P = 0.031), with the presence of previous hypertension (HR 2.7; 95% CI 1.43-5.07, P = 0.002), and if AF is permanent (HR 2.23; 95% CI 1.08-4.59, P = 0.042). In addition, larger anteroposterior left atrial diameter (LAD) (HR 1.11; 95% CI 1.05-1.18, P = 0.001) and larger left ventricular end-systolic diameter (HR 1.07; 95% CI 1.00-1.15, P = 0.029) prior to the procedure were associated with AF recurrence after CPVA. Cox regression analysis showed that hypertension (OR = 2.8; 95% CI 1.5-5.4; P = 0.002) and LAD (OR = 1.1; 95% CI 1.05-1.19, P < 0.001) were independent predictors of AF recurrence. The mean predicted proportion of patients with AF recurrence after CPVA of the multivariable model showed a linear relationship with the increase in LAD prior to the procedure. The presence of hypertension further increased the mean predicted proportion of patients with AF recurrence at each LAD. CONCLUSION: Hypertension and LAD are independent pre-procedural predictors of AF recurrence after CPVA to treat AF. These data may help in patient selection for AF ablation.