Predictors of late recurrence of atrial tachyarrhythmias after catheter ablation in patients with atrial fibrillation

AIM:To investigate the predictors of late recurrence of atrial tachyarrhythmias after catheter ablation in patients with atrial fibrillation (AF). METHODS: A total of 117 patients (81 males, 36 females) with AF (paroxysmal, 80; persistent, 37) who received radiofrequency catheter ablation were enrolled in this study. All patients underwent circumferential pulmonary vein ablation (CPVA) guided by three-dimensional electroanatomical mapping system (CARTO). The endpoint of CPVA was pulmonary vein isolation (PVI). Left atrial linear ablations and right atrial linear ablations would be performed after PVI if AF could not be terminated at the end of ablation. External cardioversion was needed if AF was still sustained. Uni- and multivariate analysis were carried out to assess the predictive value of 18 clinical and procedural variables for late recurrence (>3 months) of AF after the initial catheter ablation procedure. RESULTS: PVI was achieved in all patients. Left atrial linear ablations and right atrial linear ablations were performed after PVI in 58 patients. AF remained after radiofrequency catheter ablation in 37 patients. However, all external cardioversions were successful. Thirty-two patients (27.3%) had late recurrence of AF. Univariate analysis showed that six clinical variables were related to the late recurrence of AF: AF duration; persistent AF; presence of associated structural heart disease; left atrial enlargement; LVEF; and no termination of AF during energy delivery and need of cardioversion (P<0.05). Multivariate analysis found that only gender, AF duration and left atrial enlargement could predict the late recurrence of AF (P=0.0261; 0.0185; 0.0002). CONCLUSION: AF duration, persistent AF, presence of associated structural heart disease, left atrial enlargement, LVEF, and no termination of AF during energy delivery and need of cardioversion are related to the late recurrence of AF. Gender, AF duration and left atrial enlargement are independent predictors for the late recurrence of AF.