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Predictors of atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review.
MedLine Citation:
PMID:  20487117     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
INTRODUCTION: The relationship between success of radiofrequency ablation for atrial fibrillation (AF) and patient characteristics has not been systematically evaluated.
METHODS AND RESULTS: We searched MEDLINE and Cochrane Central Trials Registry databases from 2000 through 2008 for studies reporting preprocedure predictors and AF recurrence after radiofrequency ablation. We extracted multivariable analyses and univariable data on predictors and AF recurrence. Eligible studies were highly heterogeneous, particularly regarding ablation technique and definition of AF recurrence. Among 25 studies with multivariable analyses, two-thirds to 90% of studies found that AF type, ejection fraction, left atrial diameter, structural heart disease, hypertension, and AF symptom duration did not predict AF recurrence (among patients with ejection fraction above 40% and left atrial diameter below about 55 mm). Studies found that gender and age were not predictors (in patients between 40 and 70 years old). Meta-analyses of univariable AF recurrence rates by AF type in 31 studies found that studies were statistically heterogeneous, but that nonparoxysmal AF predicted AF recurrence compared to paroxysmal AF (relative risk 1.59; 95% confidence interval 1.38-1.82; P < 0.001); meta-analyses of persistent or permanent versus paroxysmal AF yielded similar findings.
CONCLUSION: Nonparoxysmal AF may be a clinically useful proxy for a combination of confounded variables, none of which alone is an independent predictor of AF recurrence. Evaluation of predictors was limited by exclusion of patients with severe heart disease or at the age extremes; thus, the evidence may not be as applicable to these populations.
Authors:
Ethan M Balk; Ann C Garlitski; Alawi A Alsheikh-Ali; Teruhiko Terasawa; Mei Chung; Stanley Ip
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1208-16     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Affiliation:
Tufts Evidence-based Practice Center, TuftsMedical Center, Boston, Massachusetts, USA. ebalk@tuftsmedicalcenter.org
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