肺静脉结构特点及左心房内径与心房颤动经导管射频消融术后复发的关系

目的 探讨肺静脉结构特点及左心房内径(LAD)与心房颤动(房颤)经导管射频消融术后复发的相关性.方法 收集267例经导管射频消融房颤患者的术前资料,通过经食管超声心动图测量LAD,螺旋CT测量左上肺静脉(LSPV)、左下肺静脉(LIPV)、右上肺静脉(RSPV)和右下肺静脉(RIPV)的CT值及肺静脉变异情况.所有患者都成功进行经导管射频消融治疗,并在术后随访10个月.通过单因素和多因素Cox回归分析肺静脉结构特点,LAD及其他因素与术后复发的相关性.结果 267例入选患者中,复发44例.复发组与无复发组相比,LAD、LSPV、RSPV、左侧总肺静脉和上侧总肺静脉平均直径明显增大(P＜0.05).经单因素及多因素Cox回归分析显示LAD、上侧总肺静脉直径、房颤类型以及房颤病程是房颤射频消融术后复发的独立危险因素.结论 LAD越大、上肺静脉开口越宽的房颤患者,经导管射频消融术后越容易复发,而病程较长和持续性房颤亦是房颤射频消融术后复发的独立预测因素.     

伊布利特在转复导管消融术后持续性心房颤动中的应用以及对术后心房颤动复发的预测

目的:观察伊布利特在转复导管消融术后持续性心房颤动(房颤)的有效性及安全性,以及复律成功与否对导管消融术后房颤复发的预测。方法:入选2014-08-2016-08在郑州大学人民医院接收导管射频消融术但术后未能转复窦性心律(窦律)的持续性房颤患者248例,其中男146例,女102例;平均年龄(63.9±7.2)岁。术中静脉推注伊布利特1 mg,若仍未转复,则再次给予1 mg。若仍未恢复窦律,则根据情况给予超速抑制或电复律。依据"2C3L"术式导管消融+伊布利特应用后是否恢复窦律将患者分为有效组和无效组。比较2组患者的临床资料的差异,观察伊布利特在转复导管消融术后持续性房颤中的有效性及安全性;随访24个月,观察2组患者房颤的早期及晚期复发率。统计复律成功与否对导管消融术后房颤复发的预测效果。结果:伊布利特转复导管消融术后持续性房颤的总成功率为72.1%,无严重不良事件发生。2组患者在房颤持续时间、左房内径、射血分数值、BNP水平均差异有统计学意义;在年龄、性别、合并疾病(高血压病、糖尿病、冠心病)等差异均无统计学意义。经"2C3L"术式导管消融+伊布利特应用后恢复窦律者的房颤早期复发及晚期复发率均较未恢复窦律者低。结论:伊布利特转复导管消融术后持续性房颤的成功率高、安全性良好,且伊布利特复律成功预示房颤导管消融术后早期、晚期复发均较低。     

B型心房利钠肽对心房颤动术后晚期复发的预测价值

目的:探讨B型心房利钠肽(BNP)对心房颤动(房颤)患者行经导管射频消融治疗术后晚期复发率的预测价值。方法:选择2012-03-2013-03在我院住院并接受射频导管消融术治疗的房颤患者,进行前瞻性随机对照研究。所有患者于术前监测BNP水平。手术结束时评价是否由房性心律转复为窦性心律,或阵发性房颤患者是否维持窦性心律。术后随访,于1、3、6、12个月了解房颤复发情况。结果:接受射频导管消融术治疗的房颤患者1 346例,其中741例术前监测BNP水平正常,605例术前监测BNP水平升高。单因素分析,术前BNP升高组,无论术中能否转复窦性心律的概率、术后早期复发率、术后1年内晚期复发率均高于术前BNP正常组,BNP是房颤术后复发的预测因子。但校正房颤类型、年龄、性别、房颤病程、左房大小等因素后,Cox多元回归分析,P0.05。结论:单因素分析BNP水平可能是房颤患者行经导管射频消融治疗术手术成功的预测因子之一。多因素分析后,BNP不是房颤患者行经导管射频消融治疗术术后复发的独立预测因子。     

心房颤动导管消融术后极晚期复发及其相关因素的研究

目的研究房颤导管消融术后极晚期复发患者的临床特点及极晚期复发的临床预测因素。方法对心房颤动导管消融治疗后的复发患者进行回顾性研究,分析其临床特征并总结出极晚期复发的临床预测因素。结果共计235例患者入选该研究,射频消融后平均随访(18.2±4.6)个月,12例(5.1%)患者出现极晚期复发。极晚期复发、晚期复发与无复发3组患者组间比较显示,持续性房颤、术中电复律比例、完全肺静脉隔离率以及早期复发发生率在3组间差异具有统计学意义。Logistic单因素分析显示,早期复发(OR9.223,95%CI2.087～30.409;P=0.002)、持续性房颤(OR4.799,95%CI1.152～12.777;P=0.028)与极晚期复发相关。Logistic多元回归分析显示,早期复发是极晚期复发的惟一临床预测指标(OR=7.798,95%CI1.893～38.249;P=0.005)。结论心房颤动射频消融术后极晚期复发并不常见,其发生与消融后早期复发相关。     

心房纤颤患者射频消融术后复发的相关因素分析

目的探讨心房纤颤(房颤)经导管射频消融术后与复发相关的预测因素及可能机制。方法收集2015年1月~2015年5月,天津医科大学总医院行射频消融术的房颤患者105例。根据术后复发与否,分为复发组(n=24)、无复发组(n=81),比较两组间临床资料差异。采用多因素Logistic回归分析筛选影响房颤患者射频消融术后复发的独立预测因素。结果两组患者间比较,性别、年龄、房颤病史、体质指数(BMI)、器质性心脏病、高血压、糖尿病、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)水平无统计学差异(P0.05)。房颤类型、左房前后径(LA)、术中电复律、术后早期复发,两组间有统计学差异(P0.05),纳入多因素logistic回归分析,提示术后早期复发是房颤消融术后复发的独立预测因素(OR=5.236,95%CI:1.747~15.690,P0.01)。术后空白期内房性心律失常发作多出现在术后1月内,且1月后仍有发作者,房颤晚期复发的风险明显增加。结论房颤术后早期复发(空白期内)是房颤消融术后复发的独立预测因素,且消融后1月后仍有发作的患者,房颤晚期复发的风险明显增加。     

环肺静脉左心房线性消融术后复发的房性心律失常

目的研究心房颤动(房颤)患者环肺静脉左心房线性消融术后复发房性心律失常的机制。方法28例房颤患者接受环肺静脉左心房线性消融术,平均年龄(54±11)岁,其中阵发性房颤10例,持续性房颤18例。采用Carto电解剖标测系统及双Lasso标测导管技术,分别进行环左、右侧肺静脉线性消融;消融终点为肺静脉电位消失,左心房-肺静脉双向阻滞。复发患者再次消融术采用双Lasso导管指导在原环形消融线上标测“漏点”并消融封闭之,对不能终止心动过速者再行拖带标测、激动标测或结合Carto系统标测;对典型心房扑动(房扑)行右心房峡部线性消融。结果初次消融术后平均随访(245±65)d,18例无复发;8例复发房性心律失常包括5例典型房扑、2例其他房性心动过速、1例阵发性房颤;2例左上肺静脉电位未完全隔离者仍持续房颤。除外1例持续性房颤,另外9例接受了再次消融术,证实所有复发患者均有左心房-肺静脉传导恢复;8例射频消融成功并随访(192±92)d无复发。结论左心房-肺静脉传导恢复是环肺静脉左心房线性消融术后复发房性心律失常的重要因素;初次手术附加右心房峡部线性消融可能减少复发率。     

持续性心房颤动消融术后复发因素的探讨

目的:探讨影响持续性心房颤动(房颤)消融术后复发的因素。方法:入选症状明显、药物治疗无效的持续性房颤(持续时间>7 d)患者30例,在房颤心律下,通过三维标测系统CARTO指导行环肺静脉线性消融隔离肺静脉。隔离肺静脉后房颤仍然持续者行电击复律,术前及术中有典型心房扑动(房扑)者同时行三尖瓣环峡部消融。分别于消融前和完成预定消融策略后测量房颤周长。术后进行系统随访,根据房颤是否复发行单因素及多因素分析,确定消融成功与否的影响因素。结果:30例患者均完成双侧环肺静脉线性消融,6例恢复窦性心律,4例转为典型房扑者继续三尖瓣峡部消融,4例左房房扑及16例房颤仍然持续者行体外电击复律。随访期间,50.0%(15/30)患者出现早期(术后1个月)复发;继续随访中,40.0%(6/15)的早期复发患者实现延迟治愈,1例出现晚期复发。平均随访6~14(8.6±2.4)个月后,66.7%(20/30)的患者达到成功标准。单因素分析显示,成功组较复发组患者消融前后房颤周期变异程度较大[(14.36±10.52)%∶(4.15±3.91)%,P=0.006]、消融后房颤周长显著延长,早期复发率显著较低(30.0%∶80.0%,P=0.013)。多因素分析显示,消融后房颤周长的变化:OR=21.345,95%CI为1.429~318.795,P=0.026;术后早期复发:OR=1.27,95%CI为1.020~1.573,P=0.033。结论:消融前后房颤周长无显著性变化及术后早期复发为持续性房颤消融术后房颤复发的独立预测因素,术中监测房颤周期变化可以在一定程度上筛选那些需要额外消融的患者。     

孤立性房颤导管消融术后复发相关危险因素分析

目的回顾性分析孤立性心房颤动(房颤)导管消融术后复发的相关危险因素。方法选择河南省人民医院近10年来接受导管消融手术的孤立性房颤患者214例,根据消融效果分为复发组和消融成功组两组。对两组的假设危险因素,性别、年龄、吸烟、饮酒、消融手术史、房颤类型、房颤病程长短、发病年龄、房颤家族史、血胆固醇、三酰甘油、N端脑钠肽前体(NT-proBNP)、左房内径大小、消融手术方式等共26项指标进行单因素和多因素Logistic回归分析。结果对两组患者危险因素分析,两组间有统计学差异的因素包括:房颤家族史(P=0.0003)、左房大小(P=0.04)、环肺静脉前庭隔离术((2PVAI)术中是否采用线性消融(P=0.01)、是否进行碎裂电位(CFAE)电位消融(P=0.02)、是否通过经胸电复律恢复窦律(P=0.004)。多因素Logistic回归分析显示,房颤家族史是孤立性房颤导管消融术后复发的独立危险因素(OR=5.16,95%CI:2.73~26.13,P=0.0001)。结论房颤家族史是孤立性房颤消融术后复发的独立危险因素,具备家族史的孤立性房颤患者消融术后复发风险增加。     

双Lasso导管和三维标测指导下环肺静脉线性隔离术治疗心房颤动

目的在双Lasso导管和三维标测指导下环肺静脉线性消融并彻底隔离肺静脉以治疗心房颤动(简称房颤)。方法28例房颤患者接受射频消融治疗,其中阵发性房颤12例,持续性房颤16例。所有患者首先利用三维电解剖标测系统(CARTO)进行左房重建,然后将两根Lasso导管同时置入右(左)上下肺静脉内,在肺静脉口外0.5~1cm左右行环肺静脉线性消融,消融终点为左房-肺静脉完全性传导阻滞。结果28例均电隔离成功,肺静脉完成隔离后,共86.6%(97/112)的肺静脉内可见缓慢自律性电活动。手术时间205±67min,X线透视时间27±16min,无并发症发生。术后随访8.5±3.7个月,23例无房颤复发,总成功率82.1%。结论双Lasso导管和三维标测指导下有明确电学隔离指标的环肺静脉线性消融术治疗房颤安全而有效。     

应用心腔内超声指导局灶性心房颤动的射频消融

探讨在心腔内超声 (ICE)导引下对局灶性心房颤动 (简称房颤 )行射频消融治疗的可行性和安全性。选择 4例阵发性房颤而无器质性心脏病的患者 ,在 ICE指导下根据电生理检查的定位结果分别在左房的左上肺静脉、右上肺静脉及右房终末嵴上部进行射频消融。消融能量为 3 0 W,消融温度为 60℃ ,放电时间 87～ 12 0 s。结果 :右房内超声均可在单幅影像下动态显示卵圆窝、主动脉、左房 ,穿刺房间隔时可避免误穿主动脉或穿刺针过深穿破左房。左房内超声可显示肺静脉及其分支的内部结构以及导管与内壁的贴靠紧密与稳定程度。 1例术中房颤终止 ,术后 1天复发 ;2例消融后房早消失 ,随访一周无房颤复发 ;1例术中消融后可诱发房颤但随访半年无房颤发作。结论 :在ICE导引下对局灶性房颤进行射频消融 ,能增加安全性和可靠性 ,是一种较有前途的方法。     

心房颤动环肺静脉消融术后复发的预测因素

目的探讨心房颤动(简称房颤)环肺静脉消融术(CPVA)后复发的预测因素。方法109例接受CPVA治疗的房颤患者,在三维电解剖标测系统(CARTO)指导下行环绕同侧肺静脉的线性消融,消融终点为肺静脉电隔离(PVI)。通过对10项临床和消融过程指标进行分析,确定单次CPVA术后早期(<3个月)复发和晚期(≥3个月)复发的预测因素。结果所有患者均实现消融终点,其中59例为通过单一CPVA法(简称强化CPVA法)实现PVI,50例为通过CPVA联合肺静脉口节段性消融法(简称改良CPVA法)实现PVI。49例(45.0%)在术后早期复发房性快速心律失常(ATa)。单因素分析显示左房增大、合并器质性心脏病和改良CPVA法是术后早期复发的预测指标;但经多因素分析后仅有改良CPVA是独立的预测指标(P<0.001;RR4.670;95%CI1.996~10.927)。随访9.1±3.5(4~15)个月,33例(30.3%)在术后晚期复发ATa。单因素分析显示左房增大、合并器质性心脏病和改良CPVA同时也是晚期复发的预测指标,但亦仅有改良CPVA是经多因素分析确定的独立预测指标(P=0.036;RR0.391;95%CI0.613~0.941)。严重并发症包括1例心脏压塞和1例脑卒中。结论在以PVI作为房颤CPVA治疗的消融终点时,无论是术后早期复发或晚期复发,改良CPVA法均是其独立的预测因素。     

心房颤动导管消融术后电复律即刻成功预测因素分析

目的:对影响心房颤动导管消融术后3个月内复发患者直流电复律成功率的因素进行回顾性研究。方法:连续入选2010年11月至2011年11月,在北京安贞医院心内科二病房行持续性心房颤动导管消融术,且在术后3个月内因持续性房性心律失常住院行电复律的患者。禁食状态下,地西泮静脉注射镇静,行双向同步直流电复律,除颤电极片置于心尖区及胸骨旁右侧,能量依次采用50～200J。结果:共入选63例患者,年龄33～69岁,平均心房颤动病史14.6个月,左心房直径(42.8±5.2)mm,左心室射血分数(62.9±5.3)%。复发持续性心律失常中46%为心房扑动,54%为心房颤动,共进行97次电复律。患者即刻复律成功率为77%,其中80%一次放电复律成功。在年龄、性别、合并疾病、左心室射血分数、术前是否服用心律平等方面,即刻复律成功组与即刻失败组相比,两组间差异无统计学意义(P>0.05)。单因素分析示年龄、左心房扩大心房颤动持续时间与电复律即刻成功率显著相关。进行Logistic回归分析校正上述因素后发现,术前心房颤动持续时间(OR=0.957,95%CI:0.921～0.994,P=0.023)和术前服用胺碘酮是复律成功率的独立预测因素。即刻成功的定义是复律后维持窦性心律>24 h。结论:心房颤动导管消融术后早期复发的患者,术前心房颤动持续时间和术前服用胺碘酮是电复律即刻成功的独立预测因素。     

左房容积指数对导管射频消融术后房颤复发的预测价值

目的探讨左房容积指数（LAVI）对导管射频消融术（RFCA）后房颤（AF）复发的预测价值。方法对52例行RFCA的AF患者随访12个月,分析RFCA后AF复发的影响因素。结果 52例患者均完成CPVA,达到消融终点;随访12个月时未复发39例,复发12例（23.53%）,1例失访。复发与未复发者比较,其年龄、性别、左室射血分数、是否合并器质性心脏病无统计学差异,左房直径及LAVI有统计学差异（P〈0.05或〈0.01）;Logistic多元回归分析显示,LAVI为AF复发的独立危险因素（P〈0.01）。结论与左房直径比较,LAVI是更好的预测RFCA后AF复发的因素。     

Long-term efficacy of delayed cure after circumferential pulmonary vein ablation of atrial fibrillation

INTRODUCTION: The reliability of delayed cure of early recurrence of atrial fibrillation (ERAF) is still undetermined. Furthermore, the predictors of recurrence after delayed cure of ERAF are less investigated in depth. AIMS OF THE STUDY: The purpose of this study was to investigate the long-term efficacy of delayed cure of ERAF after catheter ablation of AF and explore the he predictors of recurrence after delayed cure of ERAF. METHODS AND RESULTS: We prospectively studied 300 consecutive patients with atrial fibrillation (AF) who were referred for circumferential pulmonary vein ablation (CPVA). After a follow-up of 19.2 +/- 4.1months, of the 87 patients with early recurrence of AF 41 achieved delayed cure, 11 of them reoccurred AF subsequently. Univariate analysis showed that persistent AF, absence of pulmonary vein (PV) isolation and external cardioversion were related to reoccurrence after delayed cure. Logistic regression analysis identified only absence of PV isolation as a predictor of recurrent AF after delayed cure. CONCLUSIONS: Delayed cure after CPVA is relatively common and its efficacy at long-term follow-up is reasonably consistent. However, in patients without PV isolation, delayed cure is unstable and the risk of late recurrence is increased.     

Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation

AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ablation.METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation(PVI) for AF during 2012 and 2013 guided by CT image integration(Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping(EAM) system(CT group) using standard irrigated radiofrequency catheter(Thermo Cool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor(Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter(Thermo Cool) using only EAM(Carto) system(EAM group). Linear lesions were performed according to the discretion of operator. RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group(81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant(73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up(100% vs 73%; respectively; P = 0.07). Major complications(pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.CONCLUSION:These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.     

递进式射频消融逆转伴持续性心房颤动“扩张型心肌病”20例的疗效

目的评价递进式射频消融对于心脏扩大的持续性心房颤动的临床效果。方法20例心脏扩大的持续性心房颤动患者接受在接触式三维标测系统(CARTO)指导下的递进式射频消融治疗,术中尽量终止心房颤动。手术6个月后进行随访,比较患者术前及术后的症状、左心房前后径、左心室舒张末内径、左心室收缩末内径、左心室射血分数。结果 (1)术中有40%的患者在消融过程中直接转复为窦性心律,其余经过电复律后转为窦性心律;(2)术后有15%的患者为阵发性心房扑动,85%的患者维持窦性心律;(3)术后患者症状明显好转,左心房前后径、左心室舒张末内径、左心室收缩末内径纽约心脏协会(NYHA)心功能分级较术前明显好转,差异有统计学意义(P<0.01);左心室射血分数较术前提高,差异有统计学意义(45.00%±15.00%vs.36.50%±19.50%,P<0.05)。结论对于高度选择性的伴有心脏扩大的持续性心房颤动患者进行递进式射频消融治疗是安全的,术后大部分患者可以维持窦性心律,同时心腔发生了逆重构,左心室收缩功能得以改善,心功能不全症状好转。     

Outcomes in Patients Requiring Cardioversion Following Catheter Ablation of Atrial Fibrillation

Outcomes of Cardioversion Post AF Ablation.   Introduction: Early recurrence of atrial tachyarrhythmias is commonly noted after catheter ablation of atrial fibrillation (AF). The long-term outcomes of patients who require cardioversion for persistent AF after AF ablation is not known. This study reports the outcomes of patients who underwent cardioversion for persistent AF or atrial flutter following an AF ablation procedure.
Methods: The patient population comprised 55 patients (mean age 58 ± 10 years, 35% paroxysmal) who underwent catheter ablation of AF and subsequently required electrical cardioversion for persistent AF (45 patients) or atrial flutter (10 patients). Cardioversion was defined as early (within 90 days of the ablation procedure) or late (between 90 and 180 days following ablation).
Results: The mean follow-up duration was 15 ± 8 months. Forty-six of the 55 patients (84%) patients experienced recurrence during follow-up. The average time to recurrence after cardioversion was 37 days. Of the 55 patients, 8 (15%) patients had a complete success, 11 (20%) patients had a partial success and 36 patients (65%) had a failed outcome. Seven of the 43 patients (16%) who underwent early cardioversion had a complete success as opposed to one of 12 patients (8%) who underwent late cardioversion (P = 0.49).
Conclusions: This study shows that >80% of patients who undergo cardioversion for persistent AF or atrial flutter after AF ablation have recurrence. The timing of cardioversion did not affect the outcome. These findings allow clinicians to provide realistic expectations to patients regarding the long-term outcome and/or requirement for a second ablation procedure. (J Cardiovasc Electrophysiol, Vol. 21, pp. 27–32, January 2010)     

环肺静脉消融联合心房复杂碎裂电位消融治疗心房颤动的多中心临床研究

目的 观察环肺静脉消融（CPVA）联合心房复杂碎裂电位（CFAEs）消融治疗心房颤动（房颤）的有效性和安全性.方法 通过多中心临床实时注册研究的方式收集CPVA联合CFAEs消融治疗房颤的777例有效病例资料,分析其成功率和复发率,对心脏结构和功能的影响,以及并发症发生情况.结果 在平均（6.7±3.7）个月的随访期间,CPVA联合CFAEs消融治疗房颤的成功率为81.2%,复发率为18.8%.阵发性房颤成功率为88%,持续性房颤成功率为79.5%.消融术成功患者左心房内径（LAD）、左心室舒张末期内径（LVEDD）明显减小,左心室射血分数（LVEF）显著升高,P＜0.05.消融总的并发症发生率为0.9%,其中穿刺部位血肿4例,动静脉瘘2例,心脏压塞1例.结论 CPVA联合CFAEs消融治疗房颤安全、有效,对于持续性房颤,其优势尤为明显.     

70岁以上心房颤动患者导管射频消融治疗临床分析

目的 分析70岁以上心房如动(房颤)患者导管射频消融治疗成功率及术后复发危险因素.方技,选择导管射频消融的70岁以上房颤患者107例,收集患者临床和电生理资料,采用Cox比例风险回归模型分析房颤消融术后复发危险因素.结果 107例患者中,阵发性房颤89例.持续性房颤18例.平均随访(25.2±11.5)个月,单次消融成...     

Predictors of very late recurrence of atrial fibrillation after circumferential pulmonary vein ablation

BACKGROUND: Early recurrence of atrial fibrillation (ERAF) after catheter ablation is common and has been thoroughly studied. However, very late recurrence of atrial fibrillation (VLRAF) is rarely researched, and its characteristics have not been determined. HYPOTHESIS: The aim of this study was to investigate the clinical characteristics of VLRAF after circumferential pulmonary vein ablation (CPVA), and to identify the risk factors for VLRAF. METHODS: We retrospectively studied 259 consecutive patients with atrial fibrillation (AF) who were referred for CPVA. Clinical variables were investigated and predictors of VLRAF were identified. RESULTS: A total of 249 patients were enrolled in this study. After a mean follow-up of 18.2 +/- 4.4 mo, 14 patients (5.6%) had VLRAF. Patients with VLRAF were more likely than those without recurrence to have ERAF (78.6% versus 17.8%, p = 0.000) and persistent AF (50.0% versus 13.0%, p = 0.000), but were less likely to achieve pulmonary vein (PV) isolation (78.6% versus 97.6%, p = 0.000). Bivariate analysis demonstrated that ERAF (odds ratio [OR] 8.148, 95% confidence interval [CI] 2.197-30.222; p = 0.002), persistent AF (OR 8.853, 95% CI 1.773-16.155; p = 0.003), and lack of PV isolation (OR 7.530, 95% CI 1.792-33.122; p = 0.006) were related to VLRAF. Multivariate logistic regression analysis only identified ERAF as a predictor of VLRAF after CPVA (OR 7.461, 95% CI 1.696-24.836; p = 0.006). CONCLUSIONS: Very late recurrence of AF is uncommon after CPVA. That occurs more commonly in patients with ERAF.