The Efficacy Of Circumferential Pulmonary Vein Isolation In Patients With Paroxysmal Atrial Fibrillation And The Predictive Value Of Atrial Arrhythmia In Blank Period For Recurrence After Catheter Ablation

Objective To explore the efficacy of Circumferential pulmonary vein isolation(CPVI)guided by 3-D mapping system in patients with paroxysmal atrial fibrillation(PAF),and to evaluate the predictive value of atrial arrhythmia in blanking period for recurrence after catheter ablation.Method 60 patients with paroxysmal atrial fibrillation were received CPVI,and all patients were followed with regular clinic visits after the procedure,including ECG and 24-hour Holter monitoring.We observed and compared the recurrence of atrial arrhythmia in three periods,including the early blanking period(EBP),the late blanking period(LBP)and the period after blanking.EBP/LBP was defined as the first month /second and third months of the blanking period.Results(1)60 cases underwent the procedure successfully,and there were no other complication except for 1 case of vagal reflex during procedure.(2)20patients had atrial arrhythmia recurrences in EBP,and there were 13 cases without late recurrence.Meanwhile,among 17 patients who had documented atrial arrhythmia recurrences in LBP,16 had late recurrence.The results of logistic regression analysis showed that early recurrence(OR=4.658,95%CI1.35-18.64,P<0.05)was an independent predictor for recurrence.Thus,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy that for the recurrences of atrial arrhythmia in LBP/EBP predict late recurrences were (88.9%vs38.9%,97.6%vs69.0%,94.1%vs35.0%,95.3%vs72.5%,95.0%vs60.0%),respectively.(3)Compare with preoperation,the patients with obvious symtom was fewer,the antiarrhythmic drug therapy is more effective,and the episodes of AF is less frequent with shorter durance in those 18 patients with late recurrence(P<0.05).Conclusions The CPVI guided by 3-D mapping system is safe and effective for PAF patients.Although after the first ablation,the late recurrence rate was high,the clinical symptoms of the patients with recurrence were significantly better than before ablation.The recurrences of atrial arrhythmias in LBP differ from that in EBP in clinical significance,what's more,the recurrence in LBP has greater predictive significance for the late recurrence.Therefore,patients who have recurrence in LBP are supposed to do re-ablation early.