Recurrences of atrial fibrillation after first radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation: single center follow-up

The presence of left atrial (LA) dilation, as well as the presence and extent of LA zones with abnormal myocardial voltage are among the factors for recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI). Our aim was to study the rate of recurrences after first ablation for AF in patients with and without LA dilation or abnormal myocardial voltage at follow-up. Materia l and Methods. This is a retrospective study of patients with paroxysmal AF and first PVI preceded by high density voltage mapping in sinus rhythm. Clinical and procedural characteristics, recurrence-free survival and predictors for recurrence were studied. P value < 0.05 was considered significant. Results. Sixty-three patients (65% males) were studied. Mean follow- up duration was 12 months beyond the end of the 3-month blinding period. Recurrence-free survival at 12 months was 74.8% and varied widely with the presence of LA dilation or early recurrences within the blinding period. In patients with non-dilated LA arrhythmia-free survival was 82% vs. 66% in those with LA dilation, HR = 2.61, 95% CI 1.06-6.41, logrank p = 0.07. Patients without early recurrence had 12-month recurrence-free survival of 83.8% vs. 52% in those with early recurrence, HR 4.17, 95% CI 1.48-11.76, logrank p = 0.001. The presence and area of abnormal voltage zones were not different in patients with and without recurrence. Conclusion. The rate of AF recurrences after PVI at 15 months after the procedure was 25%, but it depended highly on the early recurrences during the blinding period and the degree of LA dilation.