The Impact of Left Atrial Size on Long-Term Outcome of Catheter Ablation of Chronic Atrial Fibrillation

Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Journal of Cardiovascular Electrophysiology (Impact Factor: 2.88). 07/2009; 20(11):1211-6. DOI: 10.1111/j.1540-8167.2009.01546.x
Source: PubMed

ABSTRACT The left atrial (LA) size is an important predictor of atrial fibrillation (AF) procedural termination and the long-term outcome. We sought to evaluate the long-term outcome in regard to the LA size and procedural termination.
Eighty-seven consecutive chronic AF patients (72 males, 53 +/- 10 years) underwent 3D mapping (NavX) and ablation. A stepwise approach including circumferential pulmonary vein (PV) isolation, linear ablation, and continuous complex-fractionated electrogram (CFE) ablation (targeting fractionation intervals of < 50 ms). Electrical cardioversion was applied to those without any procedural termination. The freedom from AF was defined as the maintenance of sinus rhythm without the use of any class I or III antiarrhythmic drugs after the blanking period.
Among the 87 patients, all received a circumferential PV isolation, 93% a linear ablation, and 59% a continuous CFE ablation. Those with AF procedural termination (n = 30) had a better long-term outcome when compared with those without termination during a follow-up of 21 +/- 12 months. Moreover, a Kaplan-Meier analysis showed that in those with an LA diameter of less than 45 mm (n = 49), the freedom from AF rate was higher when procedural termination was achieved (P = 0.004). On the contrary, the outcome was comparable in those with an LA diameter of >or= 45 mm (n = 38), whether AF procedural termination occurred or not (P = 0.658).
AF procedural termination was related to the long-term success during chronic AF ablation, especially in those with an LA diameter of less than 45 mm. The favorable effect of termination decreased when the LA diameter was >or= 45 mm.

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