Left atrial strain as predictor of successful outcomes in catheter ablation for atrial fibrillation: a two-dimensional myocardial imaging study The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation. Comparison of surgical cut and sew versus radiofrequency pulmonary veins isolation for chronic permanent atrial fibrillation: a randomized study. Left atrial radiofrequency ablation during mitral valve surgery: a prospective randomized multicentre study (SAFIR). Perception of Atrial Fibrillation Before and After Radiofrequency Catheter Ablation: Relevance of Asymptomatic Arrhythmia Recurrence Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial. Comparison of the point-by-point versus catheter dragging technique for curative radiofrequency ablation of atrial fibrillation. Left atrial radiofrequency ablation during cardiac surgery in patients with atrial fibrillation. Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies - Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation. Catheter ablation of atrial fibrillation in patients with atrial septal defect: long-term follow-up results Symptomatic and asymptomatic atrial fibrillation after pulmonary vein ablation and the impact on quality of life. Second‐generation cryoballoon ablation for treatment of persistent atrial fibrillation: Three‐year outcome and predictors of recurrence after a single procedure Randomized Evaluation of Right Atrial Ablation After Left Atrial Ablation of Complex Fractionated Atrial Electrograms for Long-Lasting Persistent Atrial Fibrillation Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation. Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures. Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial.
Background The objective of this study was to investigate atrial myocardial properties through two-dimensional ( 2D ) myocardial imaging in patients with atrial fibrillation ( AF ) and its predictive role for recurrence after catheter ablation . Methods and results Echocardiographic examinations were performed in 40 patients with paroxysmal AF before catheter ablation and 40 age- and gender-matched healthy control subjects . Using a software package , bidimensional acquisitions were analyzed to measure longitudinal strain and strain rate for the left atrium ( LA ) . Systolic strain and strain rate in all eight segments , and its average values , were significantly reduced in AF patients compared to controls . During 9 months of follow-up after catheter ablation for AF , 11 of 40 AF patients had AF recurrence . AF recurrence was associated with gender , LA volume index , and average values of systolic strain and strain rate . By multivariate analysis , only average strain was an independent predictor of AF recurrence ( OR = 0.88 , 95 % CI 0.79 - 0.98 , p = 0.018 ) . Conclusions Lower systolic strain of LA was strongly associated with recurrence after catheter ablation . Thus , diverse adjunctive ablation strategies should be considered to reduce recurrence in patients with lower systolic strain BACKGROUND Given the potential complications of atrial fibrillation ( AF ) recurrence after ablation , better predictors of the effectiveness of the procedure are necessary to guide patient selection . AIM This prospect i ve study was conducted to evaluate the clinical relevance of global left atrial longitudinal strain ( GLAS ) and AF recurrence after catheter ablation . METHODS In 115 consecutive patients with AF ( persistent , n=62 ; paroxysmal , n=53 ) ,  transthoracic echocardiography was performed before catheter ablation to assess baseline left atrial mechanical function using speckle tracking echocardiography ( STE ) . RESULTS After 12 months of follow-up , 22 ( 35.5 % ) patients in the persistent AF group and 15 ( 28.3 % ) in the paroxysmal AF group exhibited AF recurrence . In both the paroxysmal and persistent AF population s , patients with recurrence presented with significantly impaired GLAS compared with patients without recurrence . Patients with recurrence also had a significantly higher pro-B-type natriuretic peptide concentration . A receiver operator curve analysis yielded area under the curve values of 0.94 and 0.86 for paroxysmal and persistent AF , respectively . In a multivariable Cox proportional-hazards analysis , GLAS was an independent predictor of AF recurrence after catheter ablation in both the paroxysmal AF group ( hazard ratio : 0.79 , 95 % confidence interval : 0.67 - 0.96 ; P=0.01 ) and the persistent AF group ( hazard ratio : 0.81 , 95 % confidence interval : 0.71 - 0.93 ; P=0.004 ) . CONCLUSIONS In both paroxysmal and persistent AF , decreased baseline left atrial deformation capabilities assessed by two-dimensional STE can help to identify patients at high risk of AF recurrence after catheter ablation . This variable may help to guide c and i date selection and improve therapeutic strategies BACKGROUND Surgical pulmonary veins isolation ( PVI ) is done to restore sinus rhythm ( SR ) in patients with chronic permanent atrial fibrillation ( CPAF ) and mitral valve disease . Here we compare the efficacy of electrical block lines performed with radiofrequency ( RF ) compared with conventional surgery . METHODS R and omized trial of 22 patients with CPAF and indication for mitral valve surgery . Ten patients underwent conventional surgery ( SURG )  and 12 RF .  To prove the efficacy of the blockage lines , epicardial pacemaker wires were placed in the isolated pulmonary veins region ( IPVR ) and right atria ( RA ) . RESULTS There were no differences in the baseline data among the groups . All patients remained in SR during the immediate postoperative period . Block lines were tested in patients who remained in SR during the following days ( eight in SURG and nine in RF ) . The median value of thresholds to conduct the stimulus of IPVR for the RA was 18 mA in SURG and 3 mA in RF ( P < 0.022 ) . Eight SURG patients and seven RF patients ( P < 0.38 ) remained in SR at hospital discharge . Eleven RF patients and one SURG required amiodarone to maintain SR ( P < 0.001 ) . The incidence of recurrent atrial fibrillation ( AF ) in the follow-up was 10.7/100 patients /year in the SURG group versus 73.1/100 patients /year in the RF group ( P = 0.009 ) . CONCLUSIONS PVI by SURG formed more effective block lines than RF . SR at hospital discharge was similar among the groups , but more amiodarone was used in RF . During follow-up , incidence of recurrent AF was higher in the RF group BACKGROUND R and omized studies evaluating left atrial radiofrequency ablation ( RFA ) in patients with persistent atrial fibrillation undergoing mitral valve surgery are scarce and monocentric . AIM To evaluate the efficacy of left atrial RFA concomitant with mitral valve surgery to restore and maintain sinus rhythm . METHODS The SAFIR is a multicentre , double-blinded , central ly r and omized study involving four university hospitals . Between December 2002 and September 2005 , 43 patients with mitral valve disease and long-st and ing , persistent atrial fibrillation ( duration > 6 months ) were included . We compared valvular surgery alone ( n=22 ) or with left atrial RFA ( n=21 ) . The main endpoint was sinus rhythm at 12 months without recurrence of arrhythmia during follow-up . Secondary endpoints were surgical adverse events , atrial fibrillation relapses , stroke and echocardiographic measurements after three and 12 months ' follow-up . Analyses of the efficacy criteria were performed on an intention-to-treat basis . RESULTS The primary endpoint occurred significantly more often in the RFA group than in the control group ( respectively , 12/21 patients [ 57 % ] vs 1/22 patients [ 4 % ] ; p=0.004 ) . There were more patients with sinus rhythm in the RFA group than in the control group at discharge ( 72.7 % vs 4.8 % ; p<0.005 ) , 3-month follow-up ( 85.7 % vs 23.8 % ; p<0.01 ) and 12-month follow-up ( 95.2 % vs 33.3 % ; p<0.005 ) . The patients in the RFA group had similar rates of postoperative complications and stroke during follow-up as those in the control group . CONCLUSIONS This multicentre study suggests that left atrial RFA is effective and safe in patients with chronic atrial fibrillation and mitral valve disease Background —The objective of this study was to assess the incidence and impact of asymptomatic arrhythmia in patients with highly symptomatic atrial fibrillation ( AF ) who qualified for radiofrequency ( RF ) catheter ablation .  Methods and Results —In this prospect i ve study , 114 patients with at least 3 documented AF episodes together with corresponding symptoms and an ineffective trial of at least 1 antiarrhythmic drug were selected for  RF ablation .  With the use of CARTO , circumferential lesions around the pulmonary veins and linear lesions at the roof of the left atrium and along the left atrial isthmus were placed . A continuous , 7-day , Holter session was recorded before ablation , right after ablation , and after 3 , 6 , and 12 months of follow-up . During each 7-day Holter monitoring , the patients recorded quality and duration of any complaints by using a detailed symptom log . More than 70 000 hours of ECG recording were analyzed . In the 7-day Holter records before ablation , 92 of 114 patients ( 81 % ) had documented AF episodes . All episodes were symptomatic in 35 patients ( 38 % ) . In 52 patients ( 57 % ) , both symptomatic and asymptomatic episodes were recorded , whereas in 5 patients ( 5 % ) , all documented AF episodes were asymptomatic . After ablation , the percentage of patients with only asymptomatic AF recurrences increased to 37 % ( P<0.05 ) at the 6-month follow-up . An analysis of patient characteristics and arrhythmia patterns failed to identify a specific subset who were at high risk for the development of asymptomatic AF . Conclusions —Even in patients presenting with highly symptomatic AF , asymptomatic episodes may occur and significantly increase after catheter ablation . A symptom-only – based follow-up would substantially overestimate the success rate . Objective measures such as long-term Holter monitoring are needed to identify asymptomatic AF recurrences after ablation BACKGROUND The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation ( MANTRA-PAF ) is a r and omized trial comparing radiofrequency catheter ablation ( RFA ) to antiarrhythmic drugs ( AADs ) as first-line treatment of paroxysmal atrial fibrillation ( PAF ) . In order to eliminate the clouding effect of crossover we performed an on-treatment analysis of the data . METHODS AND RESULTS Patients ( n=294 ) were divided into three groups : those receiving only the assigned therapy ( RFA and AAD groups ) and those receiving both therapies ( crossover group ) . The primary end points were AF burden in 7-day Holter recordings at 3 , 6 , 12 , 18 , and 24 months and cumulative AF burden in all recordings . At 24 months , AF burden was significantly lower in the RFA ( n=110 ) than in the AAD ( n=92 ) and the crossover ( n=84 ) groups ( 90th percentile 1 % vs. 10 % vs. 16 % , P=0.007 ) , and more patients were free from any AF ( 89 % vs. 73 % vs. 74 % , P=0.006 ) . In the RFA , AAD and the crossover groups 63 % , 59 % and 21 % ( P<0.001 ) of the patients had no AF episodes in any Holter recording , respectively . Quality of life improved significantly in all groups . There were no differences in serious adverse events between the RFA , AAD and crossover groups ( 19 % vs. 8 % vs. 23 % ) ( P=0.10 ) . CONCLUSIONS In the treatment of antiarrhythmic therapy naïve patients with PAF long-term efficacy of RFA was superior to AAD therapy . Thus , it is reasonable to offer RFA as first-line treatment for highly symptomatic patients who accept the risks of the procedure and are aware of frequent need for reablation(s ) BACKGROUND The relationship between the applied techniques and clinical outcomes after radiofrequency ( RF ) ablation of atrial fibrillation ( AF ) remains unclear . We compared the results of ablation by RF delivered via a point-by-point versus catheter dragging technique for the treatment of AF . METHODS This study included 66 patients with drug-refractory AF who underwent circumferential pulmonary vein ( PV ) ablation .  A point-by-point technique was used in 35 ( 53 % ) patients ( Group I ) , and catheter dragging technique in the remaining 31 ( 47 % ) patients ( Group II ) . If AF persisted or remained inducible after the PV isolation , additional ablation of complex fractionated atrial electrograms and linear ablation were performed . RESULTS Significantly , fewer RF applications were delivered in Group II than in Group I. The total RF energy duration delivered was comparable between the two groups ( P = 0.55 ) . However , the total energy of RF deliveries was significantly greater in Group II than in Group I ( P = 0.02 ) . Despite a longer fluoroscopic exposure time ( P = 0.01 ) , the total procedural duration was significantly shorter in Group II than in Group I ( P = 0.005 ) . Within 3 months after a single ablation procedure , 24 patients ( 69 % ) in Group I versus 13 patients ( 42 % ) in Group II had ≥1 recurrence(s ) of atrial tachyarrhythmias ( P = 0.03 ) . A multivariate analysis showed that a point-by-point ablation was the only independent predictor of early atrial tachyarrhythmia recurrences . CONCLUSIONS The catheter dragging technique for ablation of AF was associated with a lower early recurrence rate of atrial tachyarrhythmias than the point-by-point technique INTRODUCTION Intraoperative left atrial radiofrequency ( RF ) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation ( AF ) . The aim of this study was to verify the outcome of this technique in a controlled multicenter trial . METHODS AND RESULTS One hundred three consecutive patients ( 39 men and 65 women ; age 62 + /- 11 years ) affected by AF underwent cardiac surgery and RF ablation in the left atrium ( RF group ) . The control group consisted of 27 patients ( 6 men and 21 women ; age 64 + /- 7 years ) with AF who underwent cardiac surgery during the same period and refused RF ablation .  Mitral valve disease was present in 89 ( 86 % ) and 25 ( 92 % ) patients , respectively ( P = NS ) . RF endocardial ablation was performed in order to obtain isolation of both right and left pulmonary veins , a lesion connecting the previous lines , and a lesion connecting the line encircling the left veins to the mitral annulus . Upon discharge from the hospital , sinus rhythm was present in 65 patients ( 63 % ) versus 5 patients ( 18 % ) in the control group ( P < 0.0001 ) . Mean time of cardiopulmonary bypass was longer in the RF group ( 148 + /- 50 min vs 117 + /- 30 min , P = 0.013 ) . The complication rate was similar in both groups , but RF ablation-related complications occurred in 4 RF group patients ( 3.9 % ) . After a mean follow-up of 12.5 + /- 5 months ( range 4 - 24 ) , 83 ( 81 % ) of 102 RF group patients were in stable sinus rhythm versus 3 ( 11 % ) of 27 in the control group ( P < 0.0001 ) . The success rate was similar among the four surgical centers . Atrial contraction was present in 66 ( 79.5 % ) of 83 patients in the RF group in sinus rhythm . CONCLUSION Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients . This technique is easy to perform and reproducible . Rare RF ablation-related complications can occur . During follow-up , sinus rhythm persistence is good , and biatrial contraction is preserved in most patients BACKGROUND Inflammation plays a prominent role in the etiology of the early recurrence of  atrial fibrillation ( ERAF ) . We prospect ively compared the proportion of ERAF and time-course patterns of biomarkers between radiofrequency ( RF ) and cryoballoon ( CB ) ablation . METHODS AND RESULTS We enrolled 82 consecutive paroxysmal AF patients undergoing pulmonary vein ( PV ) isolation , performed with either a 28-mm 2nd-generation CB and 3-min freeze technique or point-by-point RF ablation .  Each group had 41 patients . In the RF group , all PVs were successfully isolated with 28.9 ± 6.5 min of RF delivery . In the CB group , a mean of 5.3 ± 1.4 applications/patient was delivered . The proportion of ERAF was similar between the groups . The time-course patterns significantly differed between the groups for high-sensitivity C-reactive protein ( hs-CRP ) value ( P=0.006 ) and myocardial injury markers ( P<0.0001 ) . Greater myocardial injury was observed in the CB than in the RF group ( P<0.0001 ) , whereas the peak hs-CRP value was comparable between the groups . The 2-day post-procedure hs-CRP value was the sole factor correlating with ERAF as identified by the multivariable analysis ( hazard ratio 1.697 ; 95 % confidence interval , 1.005 - 2.865 ; P=0.048 ) in the RF , but not the CB group . CONCLUSIONS The proportion of ERAF was comparable after RF and 2nd-generation CB ablation . Despite CB ablation exhibiting greater myocardial injury than RF ablation , the inflammatory responses were comparable between the groups . The inflammatory response extent predicted ERAF post-RF ablation but not post-CB ablation Introduction Atrial fibrillation ( AF ) is commonly found in patients with structural heart disease ( SHD ) , including atrial septal defect ( ASD ) . The feasibility and safety of ablation for AF in patients with unrepaired ASD is seldom reported . Objectives This study aims to evaluate and compare the long-term efficacy of  AF ablation  in patients with and without ASD . Methods From January 2008 to December 2012 , 18 consecutive patients were identified with medically refractory AF and an unrepaired ASD under catheter ablation .  For each ASD patient , four control subjects were matched from our data base . Results There were no significant differences between groups in terms of age , sex , type of AF , LA diameter , LVIDD , and EF . The mean procedural and fluoroscopy times were not different between the groups ( p = NS ) . After a median follow-up of 20 months , the patients in the ASD group had 44.4 % AF recurrence after a single procedure compared with 34.7 % in the control group ( p = 0.11 ) . The mean LA diameter in non-recurrent patients was smaller than in recurrent patients ( p = 0.03 ) . In univariate Cox proportional hazards analyses , the factor found to have a significant association with arrhythmia recurrences was left atrial diameter ( hazard ratio 1.059 , 95 % confidence interval 1.002 to 1.120 , p = 0.03 ) . Conclusions These results indicate that in patients with AF and an ASD amenable to percutaneous closure , a staged approach with radiofrequency ablation of AF preceding closure is a rational strategy BACKGROUND The aim of this prospect i ve study was to evaluate the recurrences of atrial fibrillation ( AF ) and flutter ( AFL ) after circumferential pulmonary vein ablation ( CPVA )  using repetitive long-term Holter recordings , and to evaluate the change in quality of life ( QoL ) , especially in patients with asymptomatic AF recurrences . METHODS A total of 149 patients with AF were followed up with 7-day Holter monitoring at 3 , 6 , and 12 months after CPVA .  We calculated the burden of AF/AFL defined as the percentage of time in AF/AFL , and patients with documented arrhythmia were divided into isolated symptomatic episodes of arrhythmia , mixed symptomatic/asymptomatic arrhythmia , or isolated asymptomatic arrhythmia . The QoL was analyzed with SF-36 question naires in patients with sinus rhythm after CPVA , and in patients with recurrence of symptomatic and asymptomatic arrhythmia , respectively . RESULTS Asymptomatic arrhythmia was observed in 44 % of the patients with documented arrhythmia at 12 months of follow-up . In patients with persistent AF , 63 % of the documented arrhythmia at 12 months of follow-up was asymptomatic and often persistent . In the subgroup of patients with asymptomatic arrhythmia , the QoL improved significantly in the physical scores , in contrast to patients with symptomatic arrhythmia who had unchanged or worsened QoL scores . CONCLUSIONS Asymptomatic arrhythmia is very common after AF ablation . Our data indicate that these patients improve their physical component of the QoL significantly , which may be considered a palliative success of treatment . We suggest that patients with asymptomatic AF recurrences are carefully evaluated before considering reablation . Repetitive rhythm monitoring after AF ablation is very important considering the postablation management of anticoagulant therapy INTRODUCTION Data on long-term outcomes of cryoballoon ( CB ) ablation for treatment of persistent atrial fibrillation ( AF ) are sparse . Here , we report the first 3-year follow-up results and predictors of success for catheter ablation using the second-generation CB in patients with persistent AF . METHODS AND RESULTS For this prospect i ve observational study , we enrolled 101 patients ablated with the second-generation CB at our institution . The endpoint was the first documented recurrence ( > 30 seconds ) of AF , atrial flutter , or atrial tachycardia after a 3-month blanking period . Follow-up data were collected during outpatient clinic visits and included Holter-ECG recordings . The impact of several variables on recurrence was evaluated by means of univariate and multivariate analyses and Cox proportional hazards regression models . After a median follow-up of 37 ( 31 of 42 ) months , recurrence was documented in 30 patients ( 29.7 % ) . The median procedure and fluoroscopy times were 120 ( 102 of 147 ) and 20 ( 16 of 27 ) minutes , respectively . Phrenic nerve palsy occurred in 2.0 % of the patients . Among the 30 patients who experienced recurrence , 16 underwent repeat ablation in radiofrequency technique . Cox regression analysis showed that left atrial area > 21 cm2 and AF history duration > 2 years independently predicted recurrence . CONCLUSIONS Sinus rhythm was maintained in a substantial proportion of patients even 3 years after CB ablation . Patients with a nonenlarged left atrium and short AF history had the best outcome Background —With electrogram-guided radiofrequency ablation ( RFA ) of long-lasting persistent atrial fibrillation ( AF ) , the best results have been reported when complex fractionated electrograms ( CFAEs ) in both the left ( LA ) and right ( RA ) atria were targeted . However , many studies have reported excellent outcomes from RFA of long-lasting persistent AF with the use of other ablation strategies that were limited to the LA . The incremental value of RFA of RA CFAEs is yet to be defined . Methods and Results —In 85 patients with long-lasting persistent AF ( age=59±10 years ) , RFA was directed at CFAEs in the LA and coronary sinus until AF terminated ( 19 ) or all identified LA CFAEs were eliminated . Sixty-six patients who remained in AF were r and omly assigned to cardioversion and no further RFA ( n=33 ) or to RFA of RA CFAEs ( n=33 ) . RA sites consisted of the crista terminalis ( 69 % ) , septum ( 38 % ) , superior vena cava ( 28 % ) , coronary sinus ostium ( 22 % ) , and the base of the appendage ( 31 % ) . AF terminated in 1 ( 3 % ) of 33 patients during RA RFA . At 17±6 months after a single ablation procedure , 74 % of the patients in whom AF terminated during LA RFA were in sinus rhythm . Rates of freedom from AF were similar in the patients r and omized to no RFA in the RA ( 24 % ) and those r and omized to RFA of RA CFAEs ( 30 % , P=0.8 ) . The ablation procedure was repeated in 26 patients ( 31 % ) for AF ( n=22 ) or atrial flutter ( n=4 ) . At 16±7 months after the final procedure , 89 % of the patients in whom AF terminated during LA RFA were in sinus rhythm . Among the r and omized patients , the proportion of patients who remained in sinus rhythm was similar in patients who did not undergo RFA of RA CFAEs ( 52 % ) and those who did ( 58 % , P=0.6 ) . Conclusion —After RFA of CFAEs in the LA and coronary sinus , ablation of CFAEs in the RA provides little or no increment in efficacy among patients with long-lasting persistent AF Objective To determine whether or not radiofrequency ablation ( RFA ) for persistent atrial fibrillation in patients with advanced heart failure leads to improvements in cardiac function . Setting Patients were recruited from heart failure outpatient clinics in Scotl and . Design and intervention Patients with advanced heart failure and severe left ventricular dysfunction were r and omised to RFA ( rhythm control ) or  continued medical treatment  ( rate control ) . Patients were followed up for a minimum of 6 months . Main outcome measure Change in left ventricular ejection fraction ( LVEF ) measured by cardiovascular MRI . Results 22 patients were r and omised to RFA and 19 to medical treatment . In the RFA group , 50 % of patients were in sinus rhythm at the end of the study ( compared with none in the medical treatment group ) . The increase in cardiovascular magnetic resonance ( CMR ) LVEF in the RFA group was 4.5±11.1 % compared with 2.8±6.7 % in the medical treatment group ( p=0.6 ) . The RFA group had a greater increase in radionuclide LVEF ( a prespecified secondary end point ) than patients in the medical treatment group ( + 8.2±12.0 % vs + 1.4±5.9 % ; p=0.032 ) . RFA did not improve N-terminal pro-B-type natriuretic peptide , 6 min walk distance or quality of life . The rate of serious complications related to RFA was 15 % . Conclusions RFA result ed in long-term restoration of sinus rhythm in only 50 % of patients . RFA did not improve CMR LVEF compared with a strategy of rate control . RFA did improve radionuclide LVEF but did not improve other secondary outcomes and was associated with a significant rate of serious complications . Clinical trials registration number NCT00292162 AIMS To assess the 1 year efficacy of pulmonary vein isolation ( PVI ) as index procedure for persistent atrial fibrillation ( PersAF ) comparing conventional radiofrequency irrigated-tip catheter ablation ( RFCA ) using contact-force technology and ablation using the second-generation cryoballoon ( CB-AdvA ) . METHODS AND RESULTS One hundred consecutive patients ( 74 male , 74 % ; mean age 62.4 ± 9.6 years ) with drug-refractory PersAF undergoing PVI using RFCA and CB-AdvA were enrolled . Follow-up was based on outpatient clinic visits including Holter-electrocardiograms . Recurrence of atrial tachyarrhythmias ( ATas ) was defined as a symptomatic or documented episode > 30 s. Among 100 patients , 50 underwent RFCA whereas 50 CB-AdvA.  Mean procedure and fluoroscopy times were 90.5 ± 41.7 vs. 140.2 ± 46.9 min and 14.5 ± 6.6 vs. 19.8 ± 6.8 min in the CB-Adv and in the RFCA group , respectively ( P < 0.01 ) . At 1 year follow-up , after a 3 months blanking period ( BP ) , freedom from ATas off-drugs after a single procedure was 60 % ( 28/50 patients ) in the CB-Adv and 56 % ( 27/50 patients ) in the RFCA group ( P = 0.71 ) . Multivariate analysis demonstrated that PersAF duration ( P = 0.01 ) and relapses during BP ( P = 0.02 ) were independent predictors of ATa recurrences following the index procedure . CONCLUSION Freedom from ATas following PersAF ablation with RFCA and CB-Adv is comparable at 1 year follow-up after a single procedure . Ablation with the CB-Adv is associated with shorter procedure time and radiation exposure as compared with RFCA . Atrial tachyarrhythmias occurrence during BP and longer time of PersAF seem to be significant predictors of arrhythmia recurrences after the index procedure OBJECTIVE Since predictors of recurrence of atrial fibrillation ( AF ) after ablation procedures are poorly defined , this prospect i ve study was conducted to assess the value of left atrial ( LA ) deformation imaging with two-dimensional speckle-tracking ( 2D-ST ) to predict AF recurrences after successful ablation procedures . METHODS AND RESULTS One hundred and three consecutive patients ( age 58.1 ± 16.6 years , 72.8 % male ) with AF ( 76 paroxysmal , 27 persistent ) and 30 matched controls underwent transthoracic echocardiography and 2D-ST-LA-deformation analysis with assessment of LA-radial and LA-longitudinal strain ( Sr , Sl ) , and velocities derived from the apical 4- and 2-chamber views ( 4CV , 2CV ) . AF recurrence was assessed during 6 months of follow-up . For determination of AF-related LA changes , AF patients were compared to controls and patients with AF recurrences after ablation procedures ( n = 30 , 29.1 % ) were compared with patients who maintained sinus rhythm ( n = 73 , 70.9 % ) . Atrial deformation capabilities were significantly reduced ( P < 0.0005 ) in patients with AF ( 4CVSl 17.8 ± 13.5 % ; 4CVSr 22.3 ± 14.9 % ; 4CV-velocities 2.53 ± 0.97 seconds ) when compared with controls ( 4CVSl 31.3 ± 12.4 % ; 4CVSr 30.3 ± 9.1 % ; 4CV-velocities 3.48 ± 1.01 cm/s ) . Independent predictors for AF recurrence after ablation procedures were 2CV-LA-global-strain ( Sr , P = 0.03 ; Sl , P = 0.003 ) , 4CV-LA-gobal-strain ( Sr , P = 0.03 ; Sl , P = 0.02 ) , and regional LA-septal wall-Sl ( P = 0.008 ) . LA-global-strain parameters were superior to regional LA function analysis for the prediction of AF recurrences , with cutoff values ( cov ) , hazard ratios ( HR ) , positive and negative predictive values ( PPV , NPV ) were : 4CVSl cov , 10.79 % ( HR 27.8 , P < 0.0005 ; PPV 78.8 % , NPV 93.9 % ) , 4CVSr cov , -16.65 % ( HR 24.8 , P < 0.0005 ; PPV 69.4 % , NPV 96.6 % ) , 2CVSl cov , 12.31 % ( HR 22.7 , P < 0.0005 ; PPV 75.8 % , NPV 95.3 % ) , and 2CVSr cov , -14.9 % ( HR 12.9 , P < 0.0005 ; PPV 64.3 % , NPV 93.2 % ) . CONCLUSION Compared with controls , AF itself seems to decrease LA deformation capabilities . The assessment of global LA strain with 2D-ST identifies patients with high risk for AF recurrence after ablation procedures . This imaging technique may help to improve therapeutic guiding for patients with AF CONTEXT Although left atrial radiofrequency ablation ( RFA ) is increasingly used for the treatment of chronic atrial fibrillation during mitral valve surgery , its efficacy to restore sinus rhythm and any result ing benefits have not been examined in the context of an adequately powered r and omized trial . OBJECTIVE To determine whether intraoperative RFA of the left atrium increases the long-term restoration of sinus rhythm and improves exercise capacity . DESIGN , SETTING , AND PATIENTS R and omized , double-blind trial performed in a single UK tertiary referral center with enrollment between December 2001 and November 2003 . A total of 101 patients referred for mitral valve surgery with at least 6 months ' history of uninterrupted atrial fibrillation were assessed for eligibility ; 97 were enrolled . Patients were followed up for 12 months . INTERVENTION Patients were r and omly assigned to undergo mitral valve surgery and RFA of the left atrium ( n = 49 ) or mitral valve surgery alone ( controls ; n = 48 ) . MAIN OUTCOME MEASURES The primary outcome measure was presence of sinus rhythm at 12 months ; secondary measures were patient functional status and exercise capacity ( assessed by shuttle-walk test ) , left atrial contractility , and left atrial and left ventricular dimension and function and plasma levels of B-type natriuretic peptide . RESULTS At 12 months , sinus rhythm was present in 20 ( 44.4 % ) of 45 RFA patients and in 2 ( 4.5 % ) of 44 controls ( rate ratio , 9.8 ; 95 % CI , 2.4 - 86.3 ; P<.001 ) . Restoration of sinus rhythm in the RFA group was accompanied by a greater improvement in mean ( SD ) shuttle-walk distance compared with controls ( + 94 [ 102 ] m vs + 48 [ 82 ] m ; P = .003 ) and a greater reduction in the plasma level of B-type natriuretic peptide ( -104 [ 87 ] fmol/mL vs -51 [ 82 ] fmol/mL ; P = .03 ) . Patients r and omized to receive RFA had similar rates of postoperative complications and deaths as control patients . CONCLUSIONS Radiofrequency ablation of the left atrium during mitral valve surgery for continuous atrial fibrillation significantly increases the rate of sinus rhythm restoration 1 year postoperatively , improving patient exercise capacity . On the basis of its efficacy and safety , routine use of RFA of the left atrium during mitral valve surgery may be justified . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00238706
Lower values of PALS are associated with an increased risk of AF recurrence after RFA .
PALS provides prognostic value in clinical practice
The usefulness of peak atrial longitudinal strain ( PALS ) in identifying patients at high risk of atrial fibrillation ( AF ) recurrence after radiofrequency ablation ( RFA )  has been investigated in several small AF population s. The aim of this systematic review and meta- analysis was to investigate whether PALS predicts recurrence of AF after RFA treatment .