Predictors of Success After a First Circumferential Pulmonary Vein Isolation For Atrial Fibrillation
T De Potter1, R Tavernier1, D Devos1
1Department of Cardiology, University Hospital Ghent, Belgium (TDP, KVB, RS, RT, MD), Department of Radiology, University Hospital Ghent, Belgium (DD), Department of Cardiology, St-Jan Hospital, Brugge, Belgium (MD, RT).
Insights
Circumferential pulmonary vein isolation (CPVI) successfully restores sinus rhythm in about 70% of atrial fibrillation (AF) patients. AF history duration and left atrial volume predict success, but cannot definitively identify non-responders.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) recurrence after catheter ablation necessitates identifying predictive factors for successful treatment.
- Circumferential pulmonary vein isolation (CPVI) is a key strategy for managing drug-refractory AF.
Purpose of the Study:
- To identify pre-procedural and procedural parameters predicting sinus rhythm maintenance after initial CPVI for AF.
- To evaluate the efficacy of CARTO-guided CPVI in patients with paroxysmal or short-standing persistent AF.
Main Methods:
- 100 patients with symptomatic, drug-refractory AF underwent CARTO-guided CPVI.
- Three-dimensional left atrial (LA) volume was assessed using CARTO geometry.
- Follow-up included symptom assessment, ECG, and 24-hour Holter monitoring for up to 28 months.
Main Results:
- 71% of patients (71/100) maintained sinus rhythm without antiarrhythmic drugs after the first CPVI.
- Significant predictors for AF freedom were longer AF history duration and larger 3D LA volume.
- A notable overlap in these parameters between successful and failed procedures was observed.
Conclusions:
- Initial CPVI achieves rhythm control in approximately 70% of symptomatic AF patients.
- AF history duration and 3D LA volume are independent predictors of success post-CPVI.
- These predictors have limitations in identifying patients unsuitable for CPVI or requiring additional ablation due to significant overlap.
Abstract:
Background: To identify and characterise pre-procedural and procedural parameters which predict maintenance of sinus rhythm after a first circumferential pulmonary vein isolation (CPVI) for recurrent atrial fibrillation (AF). Methods: 100 patients (54±10 yrs) undergoing CARTO-guided CPVI for symptomatic drug refractory, paroxysmal or shortstanding persistent AF were studied. The endpoint was complete electrical isolation within the encircled regions. 3D left atrial (LA) volume was measured by CARTO geometry. Follow-up examinations (symptoms, ECG, 24-hour ECG recording) were performed at 1 and 3 months and every 3 months thereafter. Results: After the first CPVI, 71 patients (71%) were free of AF without antiarrhythmic drug therapy (follow up:28±11 months). The only independent and significant predictors for freedom of AF after the first CPVI were duration of AF history and 3D LA volume (p<0.05). However, a significant overlap in durations of AF history and 3D LA volumes between failures and successes was observed. Conclusions: (1) Using the "circumferential pulmonary vein isolation" approach, the first catheter ablation leads to resolution of arrhythmia in ≈ 70% of symptomatic AF patients. (2) Independent predictors for freedom of AF after initial CPVI are duration of AF history and 3D LA volume. (3) Due to considerable overlap between failures and successes, these parameters can not be used to identify patients who should not undergo CPVI or in whom an additional ablation beyond CPVI is required. On the other hand, our results do suggest that an ablation strategy early in the course of AF disease can influence successful outcome.
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