Abstract
Purpose Pulmonary vein isolation (PVI) is the most effective treatment strategy for atrial fibrillation (AF). This study evaluated Pulmonary Vein Isolation Outcome Degree (PVIOD) as a new semi-quantitative measure for PVI success after a 7-year follow-up and determined predictors associated with PVIOD.Methods We enrolled 117 patients with symptomatic AF who underwent PVI and after a 7-year follow-up applied PVIOD with 4 possible outcomes. PVIOD 1 group included patients with successful single PVI. PVIOD 2 group included patients with efficacy after ≥ 2 re-PV isolation and/or additional substrate modification (ASM). PVIOD 3 group contained subjects with clinical success after PVI±ASM. Patients with procedural and clinical failure were in PVIOD 4 group.Results In multivariate ordinal logistic regression analysis PVIOD was independently associated with longstanding persistent AF with paroxysmal AF as referent category: odds ratio (OR) 4.1, 95% confidence interval (95% CI) 1.3-12.8 (P=0.014), left atrial (LA) diameter: OR 1.2, 95% CI 1.1-1.3 (P<0.001) and CHA2DS2-VASc score: OR 1.5, 95% CI 1.0-2.2 (P=0.039). LA size, CHA2DS2-VASc score and AF type predicted 7-year probability for procedural and procedural with clinical failure. LA diameter >41mm (AUC 0.741, 95% CI 0.6-0.8, P<0.001) and CHA2DS2-VASc score ≥2 (AUC 0.718, 95% CI 0.6-0.8, P<0.001) predicted long-term procedural and clinical failure. Conclusion PVIOD is a new classification for PVI success. LA diameter, CHA2DS2-VASc score and AF type are independently associated with PVIOD and predict procedural and procedural with clinical failure after the 7-year follow-up. LA diameter >41mm and CHA2DS2-VASc score ≥2 predict long-term PVI failure.