Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical and anatomic predictors of need for repeat atrial fibrillation ablation
Yaanik Desai, Mathew R Levy, Shahriar Iravanian, Edward C Clermont, Heval M Kelli, Robert L Eisner, Mikhael F El-Chami, Angel R Leon, David B Delurgio, Faisal M Merchant
Yaanik Desai, Shahriar Iravanian, Heval M Kelli, Robert L Eisner, Mikhael F El-Chami, Angel R Leon, David B Delurgio, Faisal M Merchant, Emory University School of Medicine, Atlanta, GA 30322, United States
Mathew R Levy, Shahriar Iravanian, Heval M Kelli, Mikhael F El-Chami, Angel R Leon, David B Delurgio, Faisal M Merchant, Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
Edward C Clermont, Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
Robert L Eisner, Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: Desai Y and Merchant FM contributed to study design; Desai Y, Levy MR, Iravanian S, Clermont EC, Kelli HM and Eisner RL contributed to data collection; Desai Y, Iravanian S and Merchant FM contributed to data analysis; Desai Y and Merchant FM contributed to drafting of the manuscript; all authors contributed to critical review of the manuscript.
Institutional review board statement: The Emory University institutional review board approved the study protocol.
Informed consent statement: Consent was not obtained but the presented data are anonymized and risk of identification is low. Waiver for requirement of informed consent was obtained from the Emory University Institutional Review Board.
Conflict-of-interest statement: None reported.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at faisal.merchant@emoryhealthcare.org.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Faisal M Merchant, MD, Cardiology Division, Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6
th Floor, Atlanta, GA 30322, United States.
faisal.merchant@emoryhealthcare.org
Telephone: +1-404-6862504 Fax: +1-404-6864826
Received: January 12, 2017
Peer-review started: January 16, 2017
First decision: February 20, 2017
Revised: June 30, 2017
Accepted: July 14, 2017
Article in press: July 17, 2017
Published online: September 26, 2017
Processing time: 255 Days and 22.7 Hours
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.
Core tip: Among patients undergoing initial atrial fibrillation ablation, those with larger pulmonary vein (PV) size determined by pre-procedure cardiac magnetic resonance imaging had an increased likelihood of needing repeat ablation procedures. Each millimeter increase in PV diameter was associated with an approximately 5%-10% increased risk of requiring repeat procedures.
