The efficacy of thoracic vein isolation (TVI), known as an approach to trigger atrial fibrillation (AF), for the management of AF has been established. Our goal was to identify the predictors for late recurrence of atrial tachyarrhythmias (ATA), for which the patients and procedural and/or echocardiographic parameters were retrospectively analyzed. Although substrate modification in the atrium for the treatment of AF ablation remains controversial, the background associated with the outcome has not been fully investigated. We retrospectively studied 33 patients with paroxysmal AF and 21 with persistent AF undergoing TVI with defragmentation. We evaluated the late/early recurrences, defined as ATA at 3 months after/within the single procedure.
During a median follow-up period of 22 (11–37) months, 28 patients (52%) experienced a late recurrence. There was a higher incidence of late recurrences in the patients with disease durations of ≥12.4 months, which was the optimal cut-off point measured in the receiver operating characteristic curve analysis, or in those with left atrial diameter >50 mm or with earlier recurrences than the others (19% versus 72%, p= 0.01; 0% versus 37%, p= 0.02; or 13% versus 53%, p< 0.0001 by the log-rank test, respectively). Moreover, there was a trend toward a higher atrial tachycardia (AT)-free rate in the patients with AF termination during the procedure (75% versus 54%, p= 0.07 by the log-rank test). A multivariate analysis based on the Cox proportional hazard model showed that disease duration ≥12.4 months or early recurrence were highly associated with the outcomes (HR 3.72, 95%CI 1.42–12.79, p<0.006; HR 4.80, 95%CI 2.24–10.56, p<0.0001).
We concluded that a longer AF duration or early ATA recurrence were associated with late ATA recurrence following TVI with defragmentation. Secondary AT might be avoidable when sinus restoration could be achieved during the procedure.
Credits: Kyoichiro Yazaki, Masahiro Watarai, Kenji Enta, Mitsuru Kahata, Asako, Kumagai, Koji Inoue, Hiroshi Koganei, Masato Otsuka, Yasuhiro Ishii