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QUARTERLY FOCUS ISSUE: HEART RHYTHM DISORDER: CLINICAL RESEARCH

Clinical Predictors of Termination and Clinical Outcome of Catheter Ablation for Persistent Atrial Fibrillation

Seiichiro Matsuo, MD^_*,_*, Nicolas Lellouche, MD^_*, Matthew Wright, MBBS, PhD^_*, Michela Bevilacqua, MD^_*, Sébastien Knecht, MD^_*, Isabelle Nault, MD^_*, Kang-Teng Lim, MD^_*, Leonardo Arantes, MD^_*, Mark D. O'Neill, MB, BCh, DPhil^_*, Pyotr G. Platonov, MD, PhD, Jonas Carlson, MSC, PhD, Frederic Sacher, MD^_*, Mélèze Hocini, MD^_*, Pierre Jaïs, MD^_* and Michel Haïssaguerre, MD^_*

^_* Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
Department of Cardiology, Lund University Hospital, Lund, Sweden

Manuscript received October 15, 2008; revised manuscript received December 2, 2008, accepted January 8, 2009.

^_* Reprint requests and correspondence: Dr. Seiichiro Matsuo, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France (Email: mattsuu{at}tc4.so-net.ne.jp).

Objectives: This study evaluated the role of pre-procedural clinical variables to predict procedural and clinical outcomes of catheter ablation in patients with long-lasting persistent atrial fibrillation (AF).

Background: Catheter ablation of persistent AF remains a challenging task.

Methods: Catheter ablation was performed in 90 patients (76 men, age 57 ± 11 years) with long-lasting persistent AF. The history of AF, echocardiographic parameters, presence of structural heart disease, and surface electrocardiogram (ECG) AF cycle length (CL) were assessed before ablation and analyzed with respect to procedural termination and clinical outcome. Mean follow-up was 28 ± 4 months.

Results: Persistent AF was terminated in 76 of 90 patients (84%) by ablation. The duration of continuous AF was shorter (p < 0.0001), the surface ECG AFCL was longer (p < 0.0001), and the left atrium was smaller (p < 0.01) in patients in whom AF was terminated by catheter ablation. The surface ECG AFCL was the only independent predictor of AF termination (p < 0.01). Maintenance of sinus rhythm was associated with a shorter duration of continuous AF (p < 0.0001), a longer surface ECG AFCL (p < 0.001), and a smaller left atrium (p < 0.05) compared with those with recurrent arrhythmia. In multivariate analysis, the surface ECG AFCL and the AF duration predicted clinical success of persistent AF ablation (p < 0.01 and p < 0.05, respectively).

Conclusions: The surface ECG AFCL is a clinically useful pre-ablation tool for predicting patients in whom sinus rhythm can be restored by catheter ablation. The duration of continuous AF and the surface ECG AFCL are predictive of maintenance of sinus rhythm.

Key Words: atrial fibrillation • catheter ablation • predictor

Abbreviations and Acronyms   AF = atrial fibrillation   CI = confidence interval   CL = cycle length(s)   ECG = electrocardiogram   LA = left atrium   LAA = left atrial appendage   PV = pulmonary vein   RAA = right atrial appendage   ROC = receiver-operator characteristic   TFA = time frequency analysis

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