Predictors of Recurrence and Outcomes in Catheter Ablation of Paroxysmal Atrial Fibrillation

pp. 240-246

Abstract

Background: Pulmonary vein isolation is currently the treatment of choice in patients with symptomatic paroxysmal atrial fibrillation refractory to antiarrhythmic therapy. Different groups specialized in treating paroxysmal atrial fibrillation have published their experience and many predictors of recurrence have been identified. However, so far, a similar experience has not been reported in our environment.

Objectives: The primary endpoint was to analyze the predictors of recurrence after pulmonary vein isolation with radiofrequency catheter ablation. The secondary endpoint was to evaluate the success rate and procedure-related complications.

Methods: A retrospective, observational and single-center study was conducted between May 2009 and August 2015 on 1,000 consecutive cases of radiofrequency catheter ablation procedures for paroxysmal atrial fibrillation guided by electroanatomical mapping. A total of 507 pulmonary vein isolation procedures with at least 1-year follow-up were analyzed, excluding repeat ablation
procedures and patients who did not complete all follow-up visits. 

Results: A multivariate analysis using the Cox regression model showed that the higher rate of episodes of atrial fibrillation before ablation [HR 1.354 (1.059-1.732); p = 0.016] and early recurrence (0-3 months) [HR 4.006 (2.703-5.937); p < 0.0001] were the most significant predictors of recurrence at 12 months. The rate of sinus rhythm maintenance at one year without antiarrhythmic treatment was 77.5% for paroxysmal atrial fibrillation, with a recurrence of 22.5%. The complications included cardiac tamponade requiring pericardiocentesis in 16 patients (1.6%), vascular complications in 21 (2.1%), transient ischemic attack in 2 (0.2%), phrenicnerve palsy in 1 (0.1%), pericarditis in 5 (0.5%) and hemothorax in 1 (0.1%).

Conclusions: Higher frequency of episodes of atrial fibrillation before pulmonary vein isolation and early recurrence are strong predictors of recurrence at one year. Pulmonary vein isolation is a safe and effective method for rhythm control in patients with symptomatic paroxysmal atrial fibrillation refractory to antiarrhythmic therapy, with a low rate of complications.