Ipsilateral Circumferential Radiofrequency Ablation of Atrial Fibrillation With Irrigated Tip Catheter

– Long-Term Outcome and Pre-Procedural Predictors –

Abstract

Background: Predictors of long-term outcome of atrial fibrillation (AF) ablation are unknown. The predictors of 5-year follow-up (FU) after single ipsilateral circumferential antrum pulmonary vein isolation (PVI) with irrigated tip catheter were investigated. Methods and Results: In 356 patients (74% male) with AF (44% paroxysmal AF [PAF]) PVI was performed. Success was defined as absence of AF, atrial flutter or tachycardia (AFLAT) recurrence. A total of 161 patients (45%) were free of AFLAT. The univariate predictors of AFLAT recurrence were: type of AF (non-PAF vs. PAF, P=0.0001), size of LA (normalized left atrium area [NLA] ≥11.5 vs. NLA <11.5, P=0.0001), renal function (glomerular filtration rate [GFR] <68ml/min vs. GFR ≥68ml/min, P=0.001) and hypertension (HT vs. no HT, P=0.025). The independent predictors of AFLAT-free survival were non-PAF (hazard ratio [HR], 1.67; 95% confidence interval [CI]: 1.23–2.26, P=0.0005), NLA ≥11.5 (HR, 1.40; 95% CI: 1.03–1.90, P=0.007) and GFR <68ml/min (HR, 1.70; 95% CI: 1.21–2.37, P=0.008). Conclusions: Single PVI results in a moderate success rate in patients with AF during 5-year FU without the use of a 3-D mapping system. Higher success was observed in patients with PAF, non-enlarged LA and good renal function.  (Circ J 2013; 77: 2280–2287)