Clinical and anatomic predictors of need for repeat atrial fibrillation ablation.

• Type of Material: Article
• Authors: Yaanik Desai, Emory University; Mathew R. Levy, Emory University; Shahriar Iravanian, Emory University; Edward C. Clermont, University of Pennsylvania; Heval M. Kelli, Emory University; Robert Eisner, Emory University; Mikhael El Chami, Emory University; Angel R. Leon, Emory University; David De Lurgio, Emory University; Faisal Merchant, Emory University
• Language: English
• Date: 2017-09-26
• Publisher: Baishideng Publishing Group Inc
• Publication Version: Final Published Version
• Copyright Statement: ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4330/wjc.v9.i9.742
• Title of Journal or Parent Work: World J Cardiol
• Volume: 9
• Issue: 9
• Start Page: 742
• End Page: 748
• Keywords: Pulmonary veins; Cardiac magnetic resonance imaging; Atrial fibrillation ablation; Imaging; Repeat ablation
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

AIM: To identify predictors of need for repeat procedures after initial atrial fibrillation (AF) ablation. METHODS: We identified a cohort undergoing first time AF ablation at our institution from January 2004 to February 2014 who had cardiac magnetic resonance (CMR) imaging performed prior to ablation. Clinical variables and anatomic characteristics (determined from CMR) were assessed as predictors of need for repeat ablation. The decision regarding need for and timing of repeat ablation was at the discretion of the treating physician. RESULTS: From a cohort of 331 patients, 142 patients (43%) underwent repeat ablation at a mean of 13.6 ± 18.4 mo after the index procedure. Both male gender (81% vs 71%, P = 0.05) and lower ejection fraction (57.4% ± 10.3% vs 59.8% ± 9.4%, P = 0.04) were associated with need for repeat ablation. On pre-ablation CMR, mean pulmonary vein (PV) diameters were significantly larger in all four PVs among patients requiring repeat procedures. In multivariate analysis, increased right superior PV diameter significantly predicted need for repeat ablation (odds ratio 1.08 per millimeter increase in diameter, 95%CI: 1.00-1.16, P = 0.05). There were also trends toward significance for increased left and right inferior PV sizes among those requiring repeat procedures. CONCLUSION: Increased PV size predicts the need for repeat AF ablation, with each millimeter increase in PV diameter associated with an approximately 5%-10% increased risk of requiring repeat procedures.