Objective: To investigate the incidence, type, and predictors of asymptomatic relapse of atrial tachy-arrhythmia (ATa) after circumferential pulmonary vein isolation (CPVI) in patients with atrial fibrillation (AF).
Methods: Forty-eight consecutive patients with AF underwent CPVI and were followed up. Forty-eight hours Holter recording was performed 1, 3, and 6 months respectively after the initial CPVI procedure. Predictors of asymptomatic ATa relapse were determined by Logistic regression analysis for eight variables as follows: age, gender, AF type, existence of organic heart disease, diameter of left atria, left ventricular ejection fraction, procedure time, and heart rate variability after the procedure.
Results: Complete Holter data were acquired in 42 patients, 26 males and 16 females, aged: 58 +/- 14, including 25 patients with paroxysmal AF and 17 with non-paroxysmal AF. The standard deviations of R-R interval (SDNN) of the non-paroxysmal AF group was 92 ms +/- 19 ms, significantly longer than that of the paroxysmal AF group (78 ms +/- 15 ms, P = 0.011). The incidence of asymptomatic ATa recurrence rates 1, 3 and 6 months after CPVI were 8%, 12%, and 8% respectively in paroxysmal AF group and 23.5%, 29.4%, and 35.3% respectively in the non-paroxysmal AF group. The incidence of asymptomatic ATa recurrence 6 months after CPVI in the non-paroxysmal AF group was significant higher than that in the paroxysmal AF group (P < 0.05). AF was the dominant arrhythmia among the asymptomatic recurrence ATa, while atrial tachycardia constituted the major arrhythmia of the symptomatic recurrent ATa.
Conclusion: (1) Asymptomatic ATa relapse is common among the patients undergoing CPVI. (2) The dominant type of asymptomatic recurrent arrhythmia is AF. (3) The independent predictors for asymptomatic ATa recurrence include non-paroxysmal AF, left atrial enlargement, and increase of SDNN.