Clinical Parameters Associated with Complete Cure of Atrial Fibrillation Undergoing Extensive Pulmonary Vein Isolation

Background: Little is known about clinical predictors for the recurrence after extensive pulmonary vein isolation (EPVI) in patients with atrial fibrillation (AF). Objectives: The purpose of this study was to investigate clinical parameters which predict complete cure of AF after EPVI. Methods and Results: A total of 152 consecutive patients with paroxysmal AF (PAF) who underwent successful EPVI were examined. We divided them into two groups, 1: Complete cure group; 103 patients who were free from PAF without any antiarrhythmic drugs and 2: recurrence group; the remaining 49 patients with recurrence of PAF. Between the two groups, we compared several clinical parameters before EPVI as follows; clinical backgrounds (presence of structural heart disease and CHADS2 score), parameters in transthoracic and transesophageal echocardiogram [left atrium (LA) dimension, systolic and diastolic LA appendage (LAA) flow velocity], LA volume assessed by multiditector CT, additional creation of cava-tricuspid isthmus block line, serum brain natriuretic peptide (BNP) level. Using multi-variate analysis, filling velocity of the LAA and BNP before EPVI were identified as the independent predictors of complete cure of PAF (p<0.001, p<0.05, respectively). Conclusion: Low BNP levels and better filling velocity of the LAA are the negative predictors for the recurrence after EPVI in patients with AF. These may relate to preserved LA function and to restricted AF substrates within PVs.