Skip to main content
SpringerLink
Log in

Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for paroxysmal atrial fibrillation without structural heart disease

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

Abstract

Background

Early recurrence of atrial fibrillation (ERAF) and delayed cure are commonly observed after atrial fibrillation (AF) ablation. The purpose of this study was to determine the predictors of ERAF and delayed cure after a single pulmonary vein isolation (PVI) performed in paroxysmal AF patients without structural heart disease.

Methods and results

In 108 consecutive patients (93 men, 15 women; mean age 51 ± 8 years) with paroxysmal AF and no structural heart disease, segmental PVI guided by a Lasso catheter was performed. Forty-one percent (44/108) AF patients had ERAF after a single PVI. Univariate analysis revealed that left atrial diameter (p = 0.004), age (p = 0.024) and P-wave dispersion (p = 0.045) were significantly related to ERAF. Logistic regression analysis revealed that left atrial enlargement was the only independent predictor of ERAF (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04–1.30, p = 0.006). Delayed cure occurred in 32% (14/44) patients with ERAF. P-wave dispersion (p = 0.001), left atrial diameter (p = 0.008) were significantly related to delayed cure. P-wave dispersion was the only independent predictive factor of delayed cure (OR 0.91; 95% CI 0.85–0.97, p = 0.004).

Conclusions

Elderly patients with left atrial enlargement and a high dispersion of P wave are susceptible to ERAF after a single PVI. Left atrial enlargement is the only independent predictor of ERAF. Among patients with ERAF, those with less P-wave dispersion and less left atrial diameter have a higher probability of delayed cure. P-wave dispersion can independently predict delayed cure.

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

Access this article

Log in via an institution

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, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339, 659–666.

    Article  PubMed  CAS  Google Scholar 

  2. Haissaguerre, M., Shah, D. C., Jais, P., Hocini, M., Yamane, T., Deisenhofer, I., et al. (2000). Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation, 102, 2463–2465.

    PubMed  CAS  Google Scholar 

  3. Lee, S. H., Tai, C. T., Hsieh, M. H., Tsai, C. F., Lin, Y. K., Tsao, H. M., et al. (2004). Predictors of early and late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation. Journal of Interventional Cardiology Electrophysiology, 10, 221–226.

    Article  Google Scholar 

  4. Bertaglia, E., Stabile, G., Senatore, G., Zoppo, F., Turco, P., Amellone, C., et al. (2005). Predictive value of early atrial tachyarrhythmias recurrence after circumferential anatomical pulmonary vein ablation. Pacing Clinical Electrophysiology, 28, 366–371.

    Article  Google Scholar 

  5. Oral, H., Knight, B. P., Ozaydin, M., Tada, H., Chugh, A., Hassan, S., et al. (2002). Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. Journal of the American College Cardiology, 40, 100–104.

    Article  Google Scholar 

  6. O’Donnell, D., Furniss, S. S., Dunuwille, A., & Bourke, J. P. (2003). Delayed cure despite early recurrence after pulmonary vein isolation for atrial fibrillation. American Journal of Cardiology, 91, 83–85.

    Article  PubMed  Google Scholar 

  7. Dong, J. Z., Liu, X. P., Long, D. Y., Liu, X. Q., Wang, J., Fang, D. P., et al. (2005). Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation. Chinese Medical Journal (Engl), 118, 1150–1155.

    Google Scholar 

  8. Vasamreddy, C. R., Lickfett, L., Jayam, V. K., Nasir, K., Bradley, D. J., Eldadah, Z., et al. (2004). Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter. Journal of Cardiovascular Electrophysiology, 15, 692–697.

    Article  PubMed  Google Scholar 

  9. Gerstenfeld, E. P., Sauer, W., Callans, D. J., Dixit, S., Lin, D., Russo, A. M., et al. (2006). Predictors of success after selective pulmonary vein isolation of arrhythmogenic pulmonary veins for treatment of atrial fibrillation. Heart Rhythm, 3, 165–170.

    Article  PubMed  Google Scholar 

  10. Andrikopoulos, G. K., Dilaveris, P. E., Richter, D. J., Gialafos, E. J., Synetos, A. G., & Gialafos, J. E. (2000). Increased variance of P-wave duration on the electrocardiogram distinguishes patients with idiopathic paroxysmal atrial fibrillation. Pacing and Clinical Electrophysiology, 23, 1127–1132.

    Article  PubMed  CAS  Google Scholar 

  11. Ozdemir, O., Soylu, M., Demir, A. D., Alyan, O., Topaloglu, S., Geyik, B., et al. (2006). Does p-wave dispersion predict the atrial fibrillation occurrence after direct-current shock therapy? Angiology, 57, 93–98.

    Article  PubMed  Google Scholar 

  12. Nanthakumar, K., Plumb, V. J., Epstein, A. E., Veenhuyzen, G. D., Link, D., & Kay, G. N. (2004). Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation, 109, 1226–1229.

    Article  PubMed  Google Scholar 

  13. Lemola, K., Hall, B., Cheung, P., Good, E., Han, J., Tamirisa, K., et al. (2004). Mechanisms of recurrent atrial fibrillation after pulmonary vein isolation by segmental ostial ablation. Heart Rhythm, 1, 197–202.

    Article  PubMed  Google Scholar 

  14. Pappone, C., Oreto, G., Rosanio, S., Vicedomini, G., Tocchi, M., Gugliotta, F., et al. (2001). Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation, 104, 2539–2544.

    PubMed  CAS  Google Scholar 

  15. Coumel, P. (1994). Paroxysmal atrial fibrillation: a disorder of autonomic tone? European Heart Journal, 15(Suppl A), 9–16.

    PubMed  Google Scholar 

  16. Martinez-Pellus, A. E., Merino, P., Bru, M., Canovas, J., Seller, G., Sapina, J., et al. (1997). Endogenous endotoxemia of intestinal origin during cardiopulmonary bypass. Intensive Care Medicine, 23, 1251–1257.

    Article  PubMed  CAS  Google Scholar 

  17. Fenelon, G., & Brugada, P. (1996). Delayed effects of radiofrequency energy: mechanisms and clinical implications. Pacing Clinical Electrophysiology, 19, 484–489.

    Article  CAS  Google Scholar 

  18. Mangrum, J. M., Everett, T. H. 4th, Mitchell, M. A., McRury, I. D., Li, H., & Haines, D. E. (2002). The effects of reverse atrial electrical remodeling on atrial defibrillation thresholds. Pacing Clinical Electrophysiology, 25, 470–476.

    Article  Google Scholar 

  19. Solti, F., Vecsey, T., Kekesi, V., & Juhasz-Nagy, A. (1989). The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovascular Research, 23, 882–885.

    Article  PubMed  CAS  Google Scholar 

  20. Spach, M. S., & Dolber, P. C. (1986). Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle: Evidence for electrical uncoupling of side-to-side fiber connections with increasing age. Circulation Research, 58, 356–371.

    PubMed  CAS  Google Scholar 

  21. Kistler, P. M., Sanders, P., Fynn, S. P., Stevenson, I. H., Spence, S. J., Vohra, J. K., et al. (2004). Electrophysiologic and electroanatomic changes in the human atrium associated with age. Journal of the American College Cardiology, 44, 109–116.

    Article  Google Scholar 

  22. Dilaveris, P. E., Gialafos, E. J., Sideris, S. K., Theopistou, A. M., Andrikopoulos, G. K., Kyriakidis, M., et al. (1998). Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. American Heart Journal, 135(5 Pt 1), 733–738.

    Article  PubMed  CAS  Google Scholar 

  23. Aras, D., Maden, O., Ozdemir, O., Aras, S., Topaloglu, S., Yetkin, E., et al. (2005). Simple electrocardiographic markers for the prediction of paroxysmal atrial fibrillation in hyperthyroidism. International Journal of Cardiology, 99, 59–64.

    Article  PubMed  Google Scholar 

  24. Kose, S., Aytemir, K., Sade, E., Can, I., Ozer, N., Amasyali, B., et al. (2003). Detection of patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation during sinus rhythm by P-wave dispersion. Clinical Cardiology, 26, 431–434.

    PubMed  Google Scholar 

  25. Tukek, T., Yildiz, P., Akkaya, V., Karan, M. A., Atilgan, D., Yilmaz, V., et al. (2002). Factors associated with the development of atrial fibrillation in COPD patients: the role of P-wave dispersion. Annals of Noninvasive Electrocardiology, 7, 222–227.

    PubMed  Google Scholar 

  26. Aytemir, K., Amasyali, B., Kose, S., Kilic, A., Abali, G., Oto, A., et al. (2004). Maximum P-wave duration and P-wave dispersion predict recurrence of paroxysmal atrial fibrillation in patients with Wolff–Parkinson–White syndrome after successful radiofrequency catheter ablation. Journal of Interventional Cardiology Electrophysiology, 11, 21–27.

    Article  Google Scholar 

  27. Gang, Y., Hnatkova, K., Mandal, K., Ghuran, A., & Malik, M. (2004). Preoperative electrocardiographic risk assessment of atrial fibrillation after coronary artery bypass grafting. Journal of Cardiovascular Electrophysiology, 15, 1379–1386.

    Article  PubMed  Google Scholar 

  28. Tezcan, U. K., Amasyali, B., Can, I., Aytemir, K., Kose, S., Yavuz, I., et al. (2004). Increased P-wave dispersion and maximum P-wave duration after hemodialysis. Annals of Noninvasive Electrocardiology, 9, 34–38.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan, 430060, China

    Hong Jiang, Zhibing Lu, Handong Lei, Dongdong Zhao, Bo Yang & Congxin Huang

Authors
  1. Hong Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhibing Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Handong Lei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dongdong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bo Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Congxin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong Jiang.

Additional information

This study was supported by National Natural Science Foundation of China. (NSFC No.30470704). There is not any potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jiang, H., Lu, Z., Lei, H. et al. Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for paroxysmal atrial fibrillation without structural heart disease. J Interv Card Electrophysiol 15, 157–163 (2006). https://doi.org/10.1007/s10840-006-9003-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-006-9003-y

Keywords

Search

Navigation