Skip to main content
Log in

Predictors of Early and Late Recurrence of Atrial Fibrillation after Catheter Ablation of Paroxysmal Atrial Fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction: The outcome of patients with early recurrence of atrial fibrillation (AF) (within one month) after ablation procedure is controversial. Furthermore, the predictors of early and late (up to mean follow-up 30 months) recurrence of AF are not investigated in depth.

Aims of the Study: The aim of the present study was to investigate the predictors of early and late recurrence of AF after catheter ablation of arrhythmogenic foci initiating AF in patients with paroxysmal AF.

Methods and Results: The study included 207 patients (155 men; mean age 62 ± 13 years) who received catheter ablation of paroxysmal AF. Eighty-one (39%) patients had early recurrence of AF. Five clinical variables were related to the early recurrence of AF: (1) old age (≥65 years) (P = 0.004); (2) presence of associated cardiovascular disease (P = 0.01); (3) presence of multiple AF foci (P = 0.004); (4) presence of AF foci from left atrial free wall (P = 0.039); (5) left atrial enlargement (P = 0.038). Multivariate analysis demonstrated that presence of multiple AF foci could predict early recurrence of AF (P = 0.013; ratio = 2.24; 95% CI 1.18 to 4.25). During the follow-up period (30 ± 11 months), 70 (34%) patients had late recurrence of AF, and two clinical variables were related to the late recurrence of AF: (1) presence of early recurrence of AF (P = 0.025); (2) presence of multiple AF foci (P = 0.034). Multivariate analysis found that presence of early recurrence of AF could predict late recurrence of AF (P = 0.046; hazard ratio = 1.62; 95% CI 1.01 to 2.59). Late recurrence of AF happened in 35 (43%) of the 81 patients with early recurrence of AF, and in 35 (28%) of the 126 patients without early recurrence of AF.

Conclusions: Early AF recurrence could predict late AF recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Mouroux AL, Metayer PL, Clementy J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med1998;339:659-666.

    Google Scholar 

  2. Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC, Hsu TL, Ding YA, Chang MS. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation1999;100:1879-1886.

    Google Scholar 

  3. Lin WS, Prakash VS, Tai CT, Hsieh MH, Tsai CF, Yu WC, Lin YK, Ding YA, Chang MS, Chen SA. Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: Implications for catheter ablation. Circulation2000;101:1274-1281.

    Google Scholar 

  4. Haissaguerre M, Jais P, Shah DC, Garrigue S, Takahashi A, Lavergne T, Hocini M, Peng JT, Roudaut R, Clementy J. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation2000;101:1409-1417.

    Google Scholar 

  5. Pappone C, Oreto G, Rosanio S, Vicedomini G, Tocchi M, Gugliotta F, Salvati A, Dicandia C, Calabro MP, Mazzone P, Ficarra E, Gioia CD, Gulletta S, Nardi S, Santinelli V, Benussi S, Alfieri O. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation2001;104:2539-2544.

    Google Scholar 

  6. Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, Scharf C, Lai SWK, Greenstein R, F Pelosi, Strickberger SA, Morady F. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation2002;105:1077-1081.

    Google Scholar 

  7. Oral H, Knight BP, Ozaydin M, Chugh A, Lai SWK, Scharf C, Hassan S, Greenstein R, Han JD, F Pelosi, Strickberger SA, Morady F. Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: Feasibility and mechanistic insights. Circulation2002;106:1256-1262.

    Google Scholar 

  8. Marrouche NF, Dresing T, Cole C, Bash D, Saad E, Balaban K, Pavia SV, Scheweikert R, Saliba W, Abdul-Karim A, Pisano E, Fanelli R, Tchou P, Natale A. Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation. J AmColl Cardiol2002;40:464-474.

    Google Scholar 

  9. Oral H, Knight BP, Ozaydin M, Tada H, Chugh A, Hassan S, Scharf C, Lai SWK, Greenstein R, F Pelosi, Strickberger SA, Morady F. Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. J Am Coll Cardiol2002;40:100-104.

    Google Scholar 

  10. Saliba W, Martin DO, Schweikert R, Gillinov M, Saad E, M Bhargava, Marrouche N. Early atrial fibrillation recurrence post pulmonary vein isolation: Should we intervene? Circulation2002;106(Suppl):II-541.

    Google Scholar 

  11. Leite L, Bluhm CM, Monahan KH, Asivatham S, Munger TM, Friedman PA, Packer DL. Long-term implications of early recurrence of atrial fibrillation following radiofrequency pulmonary vein isolation. Circulation2002;106(Suppl):II-542.

    Google Scholar 

  12. Hsieh MH, Tai CT, Tsai CF, Lin WS, Lin YK, Tsao HM, Huang JL, Ueng KC, Yu WC, Chan P, Ding YA, Chang MS, Chen SA. Clinical Outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol2003;14:598-601.

    Google Scholar 

  13. Tsao HM, Wu MH, Yu WC, Tai CT, Lin YK, Hsieh MH, Ding YA, Chang MS, Chen SA. Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol2001;12:1353-1357.

    Google Scholar 

  14. Lin WS, Tai CT, Hsieh MH, Tsai CF, Lin YK, Tsao HM, Huang JL, Yu WC, Yang SP, Ding YA, Chang MS, Chen SA. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation2003;107:3176-3183.

    Google Scholar 

  15. Hsieh MH, Chiou CW, Wen ZC, Wu CH, Tai CT, Tsai CF, Ding YA, Chang MS, Chen SA. Alterations of heart rate variability after radiofrequency catheter ablation of focal atrial fibrillation originating from pulmonary veins. Circulation1999;100:2237-2243.

    Google Scholar 

  16. Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med1997;336:1429-1434.

    Google Scholar 

  17. Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, Vander Vliet M, Collins JJ, Cohn LH, Burstin HR. Predictors of atrial fibrillation after coronary artery surgery: Current trends and impact on hospital resources. Circulation1996;94:390-397.

    Google Scholar 

  18. Coumel P. Paroxysmal atrial fibrillation: A disorder of autonomic tone? Eur Heart J1994;15(Suppl A):9-16.

    Google Scholar 

  19. Martinez-Pellus AE, Merino P, Bru M, Canovas J, Seller G, Sapina J, Fuentes T, Moro J. Endogenous endotoxemia of intestinal origin during cardiopulmonary bypass. Intensive Care Med1997;23:1251-1257.

    Google Scholar 

  20. Klein LS, Shih HT, Hackett FK, Zipes DP, Miles WM. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation1992;85:1666-1674.

    Google Scholar 

  21. Fenelon G, Brugada P. Delayed effects of radiofrequency energy: Mechanisms and clinical implications. PACE1996;19:484-489.

    Google Scholar 

  22. Nath S, Lynch C, Whayne JG, Haines DE. Cellular electrophysiological effects of hyperthermia on isolated guinea pig papillary muscle. Circulation1993;88:1826-1831.

    Google Scholar 

  23. Chiang CE, Chen SA, Wu TJ, Yang CJ, Cheng CC, Wang SP, Chiang BN, Chang MS. Incidence, significance, and pharmacological responses of catheter-induced mechanical trauma in patients receiving radiofrequency ablation for supraventricular tachycardia. Circulation1994;90:1847-1854.

    Google Scholar 

  24. Belhassen B, Viskin S, Fish R, Glick A, Glikson M, Eldar M. Catheter-induced mechanical trauma to accessory pathways during radiofrequency ablation: Incidence, predictors and clinical implications. J Am Coll Cardiol1999;33:767-774.

    Google Scholar 

  25. Tsai CF, Tai CT, Hsieh MH, Lin WS, Yu WC, Ueng KC, Ding YA, Chang MS, Chen SA. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava. Circulation2000;102:67-74.

    Google Scholar 

  26. Choi KJ, Shah DC, Hocini M, Jais P, Macle L, Weerasooriya R, Scavee C, Clementy J, Haissaguerre M. Outcome in patients with early recurrence of atrial fibrillation after PV disconnection. PACE2002;25(Part II):661.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shih-Huang Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, SH., Tai, CT., Hsieh, MH. et al. Predictors of Early and Late Recurrence of Atrial Fibrillation after Catheter Ablation of Paroxysmal Atrial Fibrillation. J Interv Card Electrophysiol 10, 221–226 (2004). https://doi.org/10.1023/B:JICE.0000026915.02503.92

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:JICE.0000026915.02503.92

Navigation