Predictors of AF Termination during Ablation Procedure and Freedom from AF Recurrence after Anatomical Linear Ablation in Longstanding, Persistent AF

Abstract

Background: There are controversies regarding the predictors of AF termination during AF substrate ablation and freedom from the recurrences during the post-ablation follow-up period in longstanding, persistent AF (LPAF). Methods and Results: Consecutive 254 patients with LPAF (AF duration (AFD): 81±101 months, LA diameter (LAD): 47±1015 mm) underwent initial ablation session for extensive PV isolation and anatomical linear ablation with procedural endpoint of AF elimination. AF termination (n=23) or conversion to atrial tachycardia (AT) (n=63) or flutter (n=22) was achieved in 108 patients (42.5%; Group-1), while AF persisted after completion of the ablation protocol in the remaining 146 patients (57.5%; Group-2). Comparison of baseline characteristics showed significant differences in AFD (68±10187 vs. 91±101109 months; P=0.03), LAD (46±1015 vs. 48±1015 mm; P<0.01) and baseline AF cycle length (183±10135 vs. 171±10135 msec; P=0.02) between Group-1 vs. Group-2, respectively. Two hundred and six patients were followed beyond the blanking period (2 months) for 417±101236 days after the initial procedure. Among the 206 patients, 108 were free from AF/AT recurrence (Group-A), while the other 98 had AF/AT recurrence (Group-B). Comparison of baseline characteristics showed significant differences in AFD (62±10170 vs. 86±10198 months; P=0.02) and LAD (46±1015 vs. 48±1016 mm; P=0.02) between Group-Avs. Group-B, respectively. Multivariate analysis identified AFD as an independent predictor of both AF elimination during ablation procedure and freedom from AF/AT recurrence after the procedure (P<0.003 for both) and AF elimination during ablation procedure as that of freedom from AF/AT recurrence after the procedure (P<0.03). Conclusions: The results of this study suggest AF elimination during ablation procedure predicts favorable post-ablation outcomes and AFD is an important limiting factor when ablation is indicated in LPAF patients.