Key result
Single ipsilateral circumferential pulmonary vein isolation resulted in a 45% freedom from atrial arrhythmia at 5 years, with non-paroxysmal AF, enlarged left atrium, and impaired renal function identified as independent predictors of recurrence.
Why the study?
Does single ipsilateral circumferential antrum pulmonary vein isolation with an irrigated tip catheter improve long-term arrhythmia-free survival in patients with drug-refractory atrial fibrillation?
Cohort (n=356)
No
Does single ipsilateral circumferential antrum pulmonary vein isolation with an irrigated tip catheter improve long-term arrhythmia-free survival in patients with drug-refractory atrial fibrillation?
Single ipsilateral circumferential pulmonary vein isolation without 3-D mapping yields a 45% 5-year success rate, with better outcomes observed in patients with paroxysmal AF, smaller left atrial size, and preserved renal function.
May inform patient selection for single ipsilateral PVI; leaves open need for RCTs versus standard techniques.
BACKGROUND: Predictors of long-term outcome of atrial fibrillation (AF) ablation are unknown. The predictors of 5-year follow-up (FU) after single ipsilateral circumferential antrum pulmonary vein isolation (PVI) with irrigated tip catheter were investigated. METHODS AND RESULTS: In 356 patients (74% male) with AF (44% paroxysmal AF [PAF]) PVI was performed. Success was defined as absence of AF, atrial flutter or tachycardia (AFLAT) recurrence. A total of 161 patients (45%) were free of AFLAT. The univariate predictors of AFLAT recurrence were: type of AF (non-PAF vs. PAF, P=0.0001), size of LA (normalized left atrium area [NLA] ≥11.5 vs. NLA <11.5, P=0.0001), renal function (glomerular filtration rate [GFR] <68ml/min vs. GFR ≥68ml/min, P=0.001) and hypertension (HT vs. no HT, P=0.025). The independent predictors of AFLAT-free survival were non-PAF (hazard ratio [HR], 1.67; 95% confidence interval [CI]: 1.23-2.26, P=0.0005), NLA ≥11.5 (HR, 1.40; 95% CI: 1.03-1.90, P=0.007) and GFR <68ml/min (HR, 1.70; 95% CI: 1.21-2.37, P=0.008). CONCLUSIONS: Single PVI results in a moderate success rate in patients with AF during 5-year FU without the use of a 3-D mapping system. Higher success was observed in patients with PAF, non-enlarged LA and good renal function.
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Wójcik et al. (2013) conducted a cohort in Atrial fibrillation (n=356). Single ipsilateral circumferential antrum pulmonary vein isolation (PVI) with irrigated tip catheter was evaluated on Freedom from atrial fibrillation, atrial flutter, or atrial tachycardia (AFLAT). Single ipsilateral circumferential pulmonary vein isolation resulted in a 45% freedom from atrial arrhythmia at 5 years, with non-paroxysmal AF, enlarged left atrium, and impaired renal function identified as independent predictors of recurrence.
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