What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=598). Intervention: Catheter ablation of atrial fibrillation. Primary outcome: Time to first documented LATAFL lasting longer than 30 s (HR 2.22, 95% CI 1.21-4.99, p=<0.0001).

July 23, 2015Open Access

Predictors of early and late left atrial tachycardia and left atrial flutter after catheter ablation of atrial fibrillation: Long-term follow-up

Q: What are the key findings of this study?

Multiple (≥2) additional lesions (HR 2.22) and an enlarged left atrium (HR 1.88) were independent predictors of left atrial tachycardia and flutter recurrence after catheter ablation of atrial fibrillation.

Key Result

Multiple (≥2) additional lesions (HR 2.22) and an enlarged left atrium (HR 1.88) were independent predictors of left atrial tachycardia and flutter recurrence after catheter ablation of atrial fibrillation.

Study Design

Type

Observational (n=598)

Multicenter

Structured PICO

What are the predictors of left atrial tachycardia and left atrial flutter recurrence in patients undergoing catheter ablation for atrial fibrillation?

Population

598 patients (age 18-80 years) with symptomatic and drug-refractory non-valvular atrial fibrillation (71% male, 41% paroxysmal AF, median age 59). Key inclusion: AF documented in at least 2 ECGs in a 3-month period preceding ablation. Key exclusion: acute reversible causes, valvular AF, prior LATAFL, LA thrombus, NYHA class IV.

Intervention

Single step-wise radiofrequency catheter ablation of atrial fibrillation (CAAF) using a 3.5-mm irrigated tip catheter, including pulmonary vein antrum isolation and potentially additional lesions (mitral isthmus line, roof line, complex fractionated electrograms ablation, and coronary sinus line) depending on arrhythmia termination.

Outcome

Time to first documented episode of left atrial tachycardia and left atrial flutter (LATAFL) lasting longer than 30 seconds, documented in any kind of ECG within a follow-up time of 60 months.hard clinical

Enlarged left atrium and the performance of multiple additional ablation lesions are independent predictors of left atrial tachycardia and flutter recurrence after catheter ablation for atrial fibrillation.

Main Result

Effect estimate: HR 2.22 (95% CI 1.21-4.99)

p-value: p=<0.0001

Limitations

Single-center, non-randomized report
Potential variability of operator experiences with the stepwise ablation approach
No protocol of LATAFL induction after CAAF procedure
Follow-up results presented without consideration of recurrences during the blanking period
Follow-up was based on clinical evaluation and 7-day Holter-ECG recordings rather than continuous monitoring with implanted devices

Abstract

BACKGROUND: The aim of the study was identification of the predictors of left atrial tachycardia and left atrial flutter (LATAFL) after radiofrequency catheter ablation of atrial fibrillation (CAAF). METHODS: We followed 598 patients (71% male, 41% paroxysmal AF; median follow-up: 36 months) after a single step-wise CAAF procedure. The time to first documented LATAFL lasting longer than 30 s, documented in any kind of electrocardiography (ECG), was defined as an end-point. RESULTS: A single CAAF procedure resulted in LATAF in 58 (10%) patients. Additional lesions were performed in 275 (46%) patients. Early LATAFL recurrence (£ 3 months since the index procedure) was observed in 11 (2%) patients. Late LATAFL (> 3 months) was noted in 47 (8%) patients. The univariate predictors of LATAFL recurrence were: type of AF (p = 0.003), the size of LA (p = 0.002) and the type of procedure (p = 0.0001). The identified single independent predictors of LATAFL recurrence were enlarged LA (p = 0.001) and mul-tiple (≥ 2) additional lesions performed during the index procedure (p < 0.0001). CONCLUSIONS: Higher rate of LATAFL recurrence was observed in patients with non-paroxysmal AF, enlarged LA and any additional lesions performed. Two independent predictors of LATAFL recurrence after CAAF were: the enlarged LA and multiple (≥ 2) additional lesions performed during the index procedure.

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