Predicting factors for atrial fibrillation acute termination during catheter ablation procedures: Implications for catheter ablation strategy and long-term outcome

BACKGROUND Termination of atrial fibrillation (AF) can be achieved by catheter ablation. It has been used as one of the procedural endpoints for AF ablation. OBJECTIVE The purpose of this study was to investigate the factors that predict AF termination and the association with Longterm outcomes. METHODS Eighty-five consecutive AF patients (33 paroxysmal, 52 nonparoxysmal) underwent three-dimensional mapping and catheter ablation. A stepwise ablation approach included circumferential pulmonary vein (PV) isolation and left atrial (LA) linear ablation, followed by LA and right atrial (RA) electrogram-based (complex fractionated atrial electrogram) ablation. Clinical and electrophysiologic characteristics were assessed to evaluate the predictors of acute AF termination. RESULTS In univariate analysis, a diagnosis of paroxysmal AF, shorter AF history, absence of history of heart failure, smaller LA diameter, Longer postablation coronary sinus cycle length, tower LA and RA mean dominant frequencies, tower RA max dominant frequency, and higher LA voltage were related to acute termination of AF during ablation. Multivariate analysis showed that smaller LA diameter and tower preablation mean RA dominant frequency were independent predictors of AF termination. Multivariate analysis also showed that larger LA diameter and the presence of RA non-PV ectopy during the index procedure could predict Late recurrence during tong-term (13 +/- 8 months) follow-up. CONCLUSION LA size and RA non-PV drivers are important for acute termination of AF and for tong-term success. Careful selection of patients, extensive RA mapping, and LA ablation may enhance tong-term ablation efficacy.