Impact of the Preprocedural Frequency of Paroxysmal Atrial Fibrillation on the Clinical Outcome after Catheter Ablation

BACKGROUND: Pulmonary vein antral isolation (PVAI) is a recommended treatment for symptomatic drug-refractory paroxysmal atrial fibrillation (PAF). PAF naturally progresses toward persistent AF with an increase in the frequency and duration of AF. The objective of this study was to evaluate whether the preprocedural AF frequency had an impact on the AF recurrence after PVAI in patients with symptomatic PAF. METHODS AND RESULTS: A total of 362 consecutive patients (61.0 ± 9.8 years; 274 males) with drug-refractory PAF who underwent PVAI were included. The preprocedural frequency of PAF was daily, weekly, monthly, and yearly in 145 (40.1%), 112 (30.9%), 90 (24.9%), and 15 (4.1%) patients, respectively. There were no significant differences in any of the preprocedural variables between the four groups, except for the number of ineffective antiarrhythmic drugs (AADs). PVAI was successfully performed in all patients. At 12 months after the initial procedure, 63.5% of the entire group of patients were free of AF recurrences without any AADs, respectively. A Cox regression multivariate analysis of the variables including the AF frequency, age, gender, duration of AF, presence of hypertension or structural heart disease, left atrial size, left ventricular ejection fraction, and body mass index demonstrated that the AF frequency was not an independent predictor of AF recurrence after a single ablation procedure (P = 0.194). CONCLUSIONS: This study demonstrated that the preprocedural AF frequency did not predict AF recurrence after PVAI in patients with PAF. From the clinical point of view, an additional AF classification based on the preprocedural AF frequency might not be valuable in patients undergoing PVAI.