Predictive value of early atrial tachyarrhythmias recurrence after circumferential anatomical pulmonary vein ablation

Objective: Radiofrequency (RF) oblation at the ostia of the pulmonary veins (PVs) to cure atria] fibrillation (AF) is often followed by early AF recurrence. The aims of this study were to determine the rate of early atria] tachyarrhythmia as recurrence after circumferential anatomical PV ablation; to evaluate whether the early recurrence of atria] tachyarrhythmias correlates with the long-term outcome of ablation; and to identify the predictors of early atria] tachyarrhythmias relapse. Methods: We studied 143 consecutive patients who underwent circumferential anatomical PV ablation. We defined early atria] tachyarrhythmias relapse as the recurrence of atria] tachyarrhythmias during the first 3 months after RF ablation. Results: After a mean follow-up of 18.7 +/- 7.2 months, 102/143 patients (71%) were deemed responders to oblation. Atria] tachyarrhythmias relapsed during the first 3 months of follow-up in 651143 (46%) patients. Patients without early atrial tachyarrhythmias relapse had a higher probability of long-term clinical success than patients with early atria] tachyarrhythmias relapse (95% vs 43%, P < 0.0001). However, patients who relapsed within the first month had 45.5% probability of long-term clinical success. On multivariate analysis, the presence of structural heart disease and the lack of a successful anatomical ablation of all targeted PV were significantly and independently correlated with early atrial tachyarrhythmias relapse. Conclusion: A delayed cure maybe expected in almost 50% of patients in whom atrial tachyarrhythmias relapses within the first month after circumferential anatomical PV ablation. The presence of structural heart disease and the lack of a successful anatomical ablation of all targeted PV predict early atrial tachyarrhythmias recurrence.