Early recurrence of atrial tachyarrhythmia post-ablation strongly predicted late recurrence compared to no early recurrence (92.3% vs 43.8%; OR 16.8, 95% CI 6.184-45.797, P<0.001).
Cohort (n=207)
Does early recurrence of atrial tachyarrhythmia predict late recurrence in patients with persistent atrial fibrillation undergoing catheter ablation?
Early recurrence of atrial tachyarrhythmia within 30 days of ablation for persistent AF is a strong independent predictor of late recurrence, challenging the assumption that it is merely a transient phenomenon.
Effect estimate: OR 16.8 (95% CI 6.184-45.797)
Absolute Event Rate: 92.3% vs 43.8%
p-value: p=<0.001
BACKGROUND: Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. METHODS: The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. RESULTS: ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184-45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003-0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. CONCLUSION: ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies.
Popa et al. (Tue,) conducted a cohort in persistent and long-standing persistent atrial fibrillation (n=207). Early recurrence of atrial tachyarrhythmia (ERAT) vs. No ERAT was evaluated on Late recurrence (LR) of atrial arrhythmia (OR 16.8, 95% CI 6.184-45.797, p=<0.001). Early recurrence of atrial tachyarrhythmia post-ablation strongly predicted late recurrence compared to no early recurrence (92.3% vs 43.8%; OR 16.8, 95% CI 6.184-45.797, P<0.001).