Clinical Predictors of Noninducibility of Sustained Atrial Fibrillation After Pulmonary Vein Isolation

Authors


  • Dr. Rotter is supported by the Swiss National Foundation for Scientific Research, Bern, Switzerland. Dr. Sanders is the recipient of a Neil Hamilton Fairley and Ralph Reader Fellowship, jointly funded by the National Health and Medical Research Council and the National Heart Foundation of Australia. Dr. Rostock is supported by the German Society of Cardiology.

  • Manuscript received 5 April 2005; Revised manuscript received 18 April 2005; Accepted for publication 9 May 2005.

Martin Rotter, M.D., Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Av. de Magellan, 33604 Bordeaux-Pessac, France. Fax: +33 557 65 65 09; E-mail: martin.rotter@gmx.ch

Abstract

Background: Noninducibility of sustained atrial fibrillation (AF) after pulmonary vein isolation (PVI) has been shown to be associated with a better clinical outcome. We evaluated the role of clinical variables that could predict noninducibility of sustained AF after PVI.

Methods and Results: Data were collected prospectively from 181 patients (153 male; age 54 ± 9 years) referred for ablation of drug-refractory symptomatic paroxysmal AF (duration ≤7 days). Clinical variables were evaluated with regard to their ability of predicting noninducibility of sustained AF (≤10 minutes) after PVI. Univariate analysis was performed on all collected variables followed by multivariate analysis for variables showing a P value <0.1. After PVI, sustained AF was noninducible in 97 (54%) patients. The following clinical variables showed a significant difference between the groups: body weight, longest AF episode, duration of AF history, presence or absence of structural heart disease, left ventricular (LV) hypertrophy, prior cardioversion, left atrial (LA) parasternal, and longitudinal diameters and LV diameters. On multivariate analysis, three independent predictors of noninducibility were identified: a shorter duration of AF episodes (AF <12 hours: RR 0.01 (0.002–0.06), P < 0.001; AF 12–48 hours: RR 0.07 (0.01–0.37), P = 0.001); LA longitudinal diameter <57 mm (RR 0.33 (0.13–0.82), P = 0.016); and absence of LV hypertrophy (RR 0.15 (0.04–0.63), P = 0.01).

Conclusions: Shorter AF episodes, smaller LA longitudinal diameter, and absence of LV hypertrophy are independent predictors of noninducibility of sustained AF after PVI.

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