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Long-Term Outcome of Catheter Ablation in Patients with Atrial Fibrillation Originating from Nonpulmonary Vein Ectopy

Authors

  • HUNG-YU CHANG M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan
    3. Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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  • LI-WEI LO M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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  • YENN-JIANG LIN M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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  • SHIH-LIN CHANG M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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  • YU-FENG HU M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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  • CHENG-HUNG LI M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • TZE-FAN CHAO M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • FA-PO CHUNG M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • TRUNG LE HA M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • RAHUL SINGHAL M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • ERIC CHONG M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • WEI-HSIAN YIN M.D.,

    1. Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • HSUAN-MING TSAO M.D.,

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
    3. Division of Cardiology, National Yang-Ming University Hospital, Taiwan
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  • MING-HSIUNG HSIEH M.D.,

    1. Division of Cardiovascular Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
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  • SHIH-ANN CHEN M.D.

    1. Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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  • This study was supported by Veterans General Hospital, Taipei, Taiwan, grant No. V99C 1-120, V101C-089, VGHUST96-P1-01, and Research Foundation of Cardiovascular Medicine, grant No. RFCM 99-01-022, RFCM 100-01-004, RFCM 100-02-011, and RFCM 101-01-001.

  • No disclosures.

Shih-Ann Chen, M.D., Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan. Fax: 886 2 2873 5656; E-mail: epsachen@ms41.hinet.net and Ming-Hsiung Hsieh, M.D., Division of Cardiovascular Medicine, Taipei Medical University-Wan Fang Hospital, 111, Sec. 3, Hsing-Long Rd, Taipei, Taiwan. Fax: 886 2 2933 9378; E-mail: td7279@ms25.hinet.net

Abstract

Long-Term Outcome of NPV AF Ablation. Introduction: Data regarding the long-term outcome of catheter ablation in patients with nonpulmonary vein (NPV) ectopy initiating atrial fibrillation (AF) are limited. We aimed to evaluate the long-term result of patients with AF who had NPV triggers and underwent catheter ablation.

Methods and Results: The study included 660 consecutive patients (age 54 ± 11 years old, 477 males) who had undergone catheter ablation for AF. Group 1 consisted of 132 patients with AF initiating from the NPV, and group 2 consisted of 528 patients with AF initiating from pulmonary vein (PV) triggers only. Patients from Group 1 were younger than those from Group 2 (51 ± 12 years old vs 54 ± 11 years old, P = 0.001) and were more likely to be females (34.4% vs 25.8%, P = 0.049). The incidences of nonparoxysmal AF (36.4% vs 16.3%, P < 0.001) and right atrial (RA) enlargement (31.3% vs 19%, P = 0.004) were higher, and the biatrial substrates were worse in Group 1 than those in Group 2 (left atrial voltage 1.5 ± 0.7 mV vs 1.9 ± 0.7 mV, P < 0.001, RA voltage 1.6 ± 0.5 mV vs 1.8 ± 0.6 mV, P = 0.014). During a follow-up period of 46 ± 23 months, there was a higher AF recurrence rate in Group 1 than in Group 2 (57.6% vs 38.8%, P < 0.001). The independent predictors of AF recurrence were NPV trigger (P < 0.001, HR 2, 95% CI 1.4–2.85), nonparoxysmal AF (P = 0.021, HR 1.55, 95% CI 1.07–2.24), larger left atrial diameter (P = 0.002, HR 1.04, 95% CI 1.02–1.07) and worse left atrial substrate (P = 0.028, HR 1.3, 95% CI 1.03–1.64).

Conclusion: Compared to AF originating from the PV alone, AF originating from the NPV ectopy showed a worse outcome. (J Cardiovasc Electrophysiol, Vol. 24, pp. 250-258, March 2013)

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