Key Points
- To identify clinical, procedural, and follow-up factors associated with early, late, and very late arrhythmia recurrences following pulmonary vein antrum isolation (PVAI) for atrial fibrillation.
- Prospective cohort analysis of 385 consecutive patients undergoing 530 PVAI procedures (mean age 58 ± 11 years; 63% paroxysmal AF) followed for a mean duration of 2.8 ± 1.2 years.
- Heart rhythm was tracked using serial ECGs and Holter monitoring at 1, 3, 6, and 12 months post-procedure and every 6 months thereafter, with predictors evaluated using Cox proportional hazards modeling.
- Late recurrences occurred in 42% of patients overall, with a significantly lower incidence in paroxysmal versus non-paroxysmal AF cohorts (39% vs 56%, P = 0.001).
- Among 256 patients followed for at least 1 year, 47% (121/256) were arrhythmia-free off antiarrhythmic drugs at 1 year, but 30% of these (36/121) subsequently developed very late recurrences.
- Multivariate analysis identified non-paroxysmal AF, hypertension, and prior antiarrhythmic drug failure as recurrence predictors, while early recurrence (< 3 months) was the strongest independent predictor of late recurrence.
Structured PICO
What are the clinical predictors of arrhythmia recurrences following pulmonary vein antrum isolation for atrial fibrillation?
PPopulation385 consecutive patients with atrial fibrillation refractory to medical therapy undergoing pulmonary vein antrum isolation (PVAI), mean age 58 ± 11 years, 63% paroxysmal AF.
IInterventionPulmonary vein antrum isolation (PVAI)
OOutcomeArrhythmia recurrences (categorized as early < 3 months, late 3 months-1 year, and very late > 1 year post-PVAI)
In patients undergoing PVAI for atrial fibrillation, non-paroxysmal AF, hypertension, prior antiarrhythmic drug failure, and early recurrences strongly predict late arrhythmia recurrences.