Skip to main content
Log in

Impact of a prolonged interatrial conduction time for predicting the recurrence of atrial fibrillation after circumferential pulmonary vein isolation of persistent atrial fibrillation

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

There are some cases that are difficult to cure with only circumferential pulmonary vein isolation (CPVI) of persistent atrial fibrillation (PerAF). Recently, prolonged interatrial conduction times (IACTs), which seem to be associated with progressive remodeled atria, have been reported as a predictor of new-onset AF. This study aimed to investigate the prognostic value of a prolonged IACT for predicting AF recurrences after CPVI of PerAF. One hundred thirteen patients who underwent CPVI without an empirical substrate modification of PerAF were retrospectively analyzed. The IACT was defined as the interval from the earliest P-wave onset on the ECG to the latest activation in the coronary sinus and was measured after achieving the CPVI and conversion to sinus rhythm. During a mean 22.7-month follow-up after the initial procedure, 56 patients (50%) had AF recurrences. Patients with AF recurrence had a longer IACT than those without AF recurrence (p < 0.001). The best discriminative cut-off value for the IACT was 123 ms (sensitivity 53%, specificity 85%). In a Cox multivariate analysis, a prolonged IACT of ≥ 123 ms was the only independent predictor (hazard ratio: 2.38; 95% confidence interval: 1.36–4.16, p = 0.002) of being associated with the incidence of an AF recurrence. Even after multiple CPVI procedures, patients with an IACT ≥ 123 ms had a higher AF recurrence rate than those with an IACT < 123 ms (p = 0.002). In conclusion, a prolonged IACT of ≥ 123 ms may be a useful marker for predicting AF recurrences after both initial and multiple CPVI procedures for PerAF.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P, Investigators STARAFII (2015) Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812–1822

    Article  PubMed  Google Scholar 

  2. Tilz RR, Rillig A, Thum AM, Arya A, Wohlmuth P, Metzner A, Mathew S, Yoshiga Y, Wissner E, Kuck KH, Ouyang F (2012) Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy. J Am Coll Cardiol 60:1921–1929

    Article  PubMed  Google Scholar 

  3. Higuchi S, Sohara H, Nakamura Y, Ihara M, Yamaguchi Y, Shoda M, Hagiwara N, Satake S (2016) Is it necessary to achieve a complete box isolation in the case of frequent esophageal temperature rises? Feasibility of shifting to a partial box isolation strategy for patients with non-paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 27:897–904

    Article  PubMed  Google Scholar 

  4. Jaïs P, Hocini M, Hsu LF, Sanders P, Scavee C, Weerasooriya R, Macle L, Raybaud F, Garrigue S, Shah DC, Le Metayer P, Clémenty J, Haïssaguerre M (2004) Technique and results of linear ablation at the mitral isthmus. Circulation 110:2996–3002

    Article  PubMed  Google Scholar 

  5. Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Ngarmukos T (2004) A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 43:2044–2053

    Article  PubMed  Google Scholar 

  6. Scherr D, Khairy P, Miyazaki S, Aurillac-Lavignolle V, Pascale P, Wilton SB, Ramoul K, Komatsu Y, Roten L, Jadidi A, Linton N, Pedersen M, Daly M, O'Neill M, Knecht S, Weerasooriya R, Rostock T, Manninger M, Cochet H, Shah AJ, Yeim S, Denis A, Derval N, Hocini M, Sacher F, Haissaguerre M, Jais P (2015) Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint. Circ Arrhythm Electrophysiol 8:18–24

    Article  CAS  PubMed  Google Scholar 

  7. Wang YS, Chen GY, Li XH, Zhou X, Li YG (2017) Prolonged P-wave duration is associated with atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review and meta-analysis. Int J Cardiol 227:355–359

    Article  PubMed  Google Scholar 

  8. Blanche C, Tran N, Rigamonti F, Burri H, Zimmermann M (2013) Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation. Europace 15:198–204

    Article  PubMed  Google Scholar 

  9. Chao TF, Sung SH, Wang KL, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Suenari K, Li CH, Ueng KC, Wu TJ, Chen SA (2011) Associations between the atrial electromechanical interval, atrial remodelling and outcome of catheter ablation in paroxysmal atrial fibrillation. Heart 97:225–230

    Article  PubMed  Google Scholar 

  10. Ejima K, Kato K, Arai K, Fukushima K, Fukushima N, Suzuki T, Yoshida K, Nuki T, Uematsu S, Hoshi H, Manaka T, Ashihara K, Shoda M, Hagiwara N (2014) Impact of atrial remodeling on the outcome of radiofrequency catheter ablation of paroxysmal atrial fibrillation. Circ J 78:872–877

    Article  PubMed  Google Scholar 

  11. Mugnai G, Chierchia GB, de Asmundis C, Juliá J, Conte G, Sieira-Moret J, Capulzini L, Wauters K, Rodriguez-Mañero M, Ciconte G, Baltogiannis G, Di Giovanni G, Saitoh Y, Brugada P (2016) P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size. J Cardiovasc Med (Hagerstown) 17:194–200

    Article  Google Scholar 

  12. Deftereos S, Kossyvakis C, Efremidis M, Bouras G, Panagopoulou V, Papadimitriou C, Doudoumis K, Deftereos G, Synetos A, Davlouros P, Toutouzas K, Alexopoulos D, Manolis AS, Giannopoulos G (2014) Interatrial conduction time and incident atrial fibrillation: a prospective cohort study. Heart Rhythm 11:1095–1101

    Article  PubMed  Google Scholar 

  13. Henmi R, Ejima K, Shoda M, Yagishita D, Hagiwara N (2016) Interatrial Conduction Time Can Predict New-Onset Atrial Fibrillation After Radiofrequency Ablation of Isolated, Typical Atrial Flutter. J Cardiovasc Electrophysiol 27:1293–1297

    Article  PubMed  Google Scholar 

  14. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ Jr, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D (2012) 2012 HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 14:528–606

    Article  PubMed  Google Scholar 

  15. Ejima K, Henmi R, Iwanami Y, Yagishita D, Shoda M, Hagiwara N (2017) Comparison of the efficacy of empiric thoracic vein isolation for the treatment of paroxysmal and persistent atrial fibrillation in patients without structural heart disease. J Cardiovasc Electrophysiol 28:266–272

    Article  PubMed  Google Scholar 

  16. Abecasis J, Dourado R, Ferreira A, Saraiva C, Cavaco D, Santos KR, Morgado FB, Adragão P, Silva A (2009) Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace 11:1289–1294

    Article  PubMed  Google Scholar 

  17. Ausma J, Litjens N, Lenders MH, Duimel H, Mast F, Wouters L, Ramaekers F, Allessie M, Borgers M (2001) Time course of atrial fibrillation-induced cellular structural remodeling in atria of the goat. J Mol Cell Cardiol 33:2083–2094

    Article  CAS  Google Scholar 

  18. Jadidi AS, Lehrmann H, Keyl C, Sorrel J, Markstein V, Minners J, Park CI, Denis A, Jaïs P, Hocini M, Potocnik C, Allgeier J, Hochholzer W, Herrera-Sidloky C, Kim S, Omri YE, Neumann FJ, Weber R, Haïssaguerre M, Arentz T (2016) Ablation of Persistent Atrial Fibrillation Targeting Low-Voltage Areas With Selective Activation Characteristics. Circ Arrhythm Electrophysiol. https://doi.org/10.1161/CIRCEP.115.002962

    Article  PubMed  Google Scholar 

  19. Masuda M, Fujita M, Iida O, Okamoto S, Ishihara T, Nanto K, Kanda T, Shiraki T, Sunaga A, Matsuda Y, Uematsu M (2016) Influence of underlying substrate on atrial tachyarrhythmias after pulmonary vein isolation. Heart Rhythm 13:870–888

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Mr. John Martin for his linguistic assistance in the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Koichiro Ejima.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Higuchi, S., Ejima, K., Shoda, M. et al. Impact of a prolonged interatrial conduction time for predicting the recurrence of atrial fibrillation after circumferential pulmonary vein isolation of persistent atrial fibrillation. Heart Vessels 34, 616–624 (2019). https://doi.org/10.1007/s00380-018-1272-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1272-8

Keywords

Navigation