Primary Outcome Measures:
Secondary Outcome Measures:
- Time to recurrence of (a)symptomatic AF [ Time Frame: 1+3+6+9+12 month ] [ Designated as safety issue: Yes ]
by assessment Percentage AF-burden on 24-holter during follow up
- Failure of rhythm control, i.e. permanent AF [ Time Frame: 1+3+6+9+12 month ] [ Designated as safety issue: Yes ]
failure of rhythm control medication or electric cardioversion.
- Risk profiles associated with early versus late AF recurrence [ Time Frame: 1month and 12 month ] [ Designated as safety issue: Yes ]
These parameters include underlying (heart) disease and risk factors (including age, family history for AF, signs of ischemia, coronary risk factors, pulmonary disease, diabetes, obesity, sleep apnea, esophageal problems), lifestyle (including caffeine and alcohol intake, exercise), autonomic trigger patterns of AF (i.e. vagal or adrenergic induced AF, or combination
- Progression of paroxysmal AF to persistent or permanent AF and of persistent AF to permanent AF [ Time Frame: 1+3+6+9+12 month ] [ Designated as safety issue: Yes ]
clinical commplaints and 3-lead Holter monitoring will be used for assessing the onset of AF episode
- Changes in atrial and ventricular echocardiographic parameters [ Time Frame: 1month and 12 month ] [ Designated as safety issue: Yes ]
Echocardiographic measures of LA size (LA size parasternal long axis view, LA volume,LA ejection fraction measurement, electro-echocardiographic parameters (Tissue Doppler total atrial conduction time (during sinus rhythm), AF cycle length and velocity (during AF)), and parameters of diastolic dysfunction, including E (early mitral valve flow velocity), A (late mitral valve flow velocity), E/A ratio, deceleration time, E' (early tissue Doppler lengthening velocity), and E/E' ratio
- Cardiovascular morbidity and mortality [ Time Frame: 1month and 12month ] [ Designated as safety issue: Yes ]
hospitalization for cardiovascular reasons, non-cardiovascular and cardiovascular death will be carefully monitored through-out the study.
- Pulmonary vein ablation [ Time Frame: 1month, 3month, 6month, 9 month, 12month ] [ Designated as safety issue: Yes ]
hospital admission for pulmonary vein ablation will be monitoring during the study.
- Pathophysiological mechanisms associated with AF and success of rhythm control [ Time Frame: baseline-12 months ] [ Designated as safety issue: No ]
To study pathophysiological mechanisms of AF, e.g. collagen mediated or inflammation mediated AF
Atrial fibrillation is responsible for substantial morbidity and mortality.Identification of patients with atrial fibrillation that is difficult to treat may improve the outcome of rhythm control therapy. Left atrial size could be a useful tool to select patients that will benefit from rhythm control therapy.Beside echocardiographic parameters,atrial fibrillation has been also associated with circulating biomarkers in blood like collagen metabolism, inflammatory mediators,neurohumoral factors and proteins/proteomic profiles. Beside more accepted risk factors (myocardial ischemia, diabetes and pulmonary disease)other less well-known clinical factors (sleep apnea, alcohol or other intoxication abuse, excessive physical activity, esophageal problems and increased body mass index) may also predict the outcome of rhythm control.It likes also plausible that recurrent atrial fibrillation within one month after start of rhythm control are associated with a different risk profile than late atrial fibrillation recurrence.During this study we will try to identify patients with atrial fibrillation who are more or less likely to respond to rhythm control therapy.