Early recurrence of AF at 0-30 and 31-90 days post-thoracoscopic ablation was associated with higher risk of late recurrence compared to no early recurrence (HR 1.52 and 2.01; P=0.002).
Cohort (n=449)
Does the timing of early recurrence after thoracoscopic AF ablation predict late recurrence and correlate with specific histological and molecular substrates?
Early recurrence after thoracoscopic AF ablation, particularly between 31-90 days, is strongly associated with late recurrence and correlates with fibro-inflammatory pathways and extracellular matrix remodeling.
Estimación del efecto: HR 1.52 and 2.01
valor p: p=.002
AbstractBackground Early recurrence (ER) of atrial fibrillation (AF) is common after ablation. However, its mechanism remains unclear. Objective To investigate the variability in the timing of ER and its relation to late recurrence (LR) and to explore potential underlying substrate. Methods We prospectively enrolled 449 patients (62 ± 9 years; 26.7% female) undergoing thoracoscopic ablation of advanced AF with concomitant left atrial appendage (LAA) excision. Rhythm surveillance was performed for 2 years. ER was defined as any atrial tachyarrhythmia >30 s within 90 days post-ablation; LR as recurrence after 90 days. Patients were categorized as having no ER, ER at 0–30 days, or ER at 31–90 days. We performed histological and bulk RNA-sequencing analyses of the excised LAA to explore different mechanisms of ER. Results ER occurred in 176/449 patients (39.2%); of whom 152 (86.4%) experienced their first ER episode within 30 days. Compared with no ER, ER at 0–30 days and 31–90 days was associated with higher LR risk (HR 1.52 and 2.01; log-rank P = .002). Higher proteoglycan content was associated with an increased risk of LR. Bulk RNA-sequencing showed that fibro-inflammatory pathways were enriched in patients with ER+LR versus patients without any recurrence. Conclusion After thoracoscopic AF ablation, ER was associated with an increased risk of LR. ER occurring at 31–90 days was associated with a higher observed risk of LR than ER occurring at 0–30 days. Exploratory findings suggested differences in extracellular matrix remodeling and inflammatory signaling across recurrence patterns.
Dong et al. (Mon,) conducted a cohort in Advanced atrial fibrillation (n=449). Early recurrence of atrial fibrillation vs. No early recurrence was evaluated on Late recurrence (recurrence after 90 days) (HR 1.52 and 2.01, p=.002). Early recurrence of AF at 0-30 and 31-90 days post-thoracoscopic ablation was associated with higher risk of late recurrence compared to no early recurrence (HR 1.52 and 2.01; P=0.002).