What does this research mean for the field?

Early recurrence of atrial tachycardia within 3 months after atrial fibrillation ablation is associated with a significantly higher rate of late recurrence, which is independently predicted by the inducibility of arrhythmias immediately after ablation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 25, 2010Open Access

Clinical Significance of Early Recurrences of Atrial Tachycardia After Atrial Fibrillation Ablation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=352). Intervention: Early recurrence of atrial tachycardia (ERAT) vs. No ERAT. Primary outcome: Late recurrence of AF or AT (p=<0.001).

Key Result

Early recurrence of atrial tachycardia within 3 months after AF ablation was associated with a higher rate of late recurrence compared to those without early recurrence (41.1% vs 11.8%, P<0.001).

Study Design

Type

Cohort (n=352)

Structured PICO

Does early recurrence of atrial tachycardia predict late recurrence of atrial fibrillation or atrial tachycardia in patients undergoing AF ablation?

Population

352 consecutive patients who underwent circumferential pulmonary vein isolation with or without linear ablation(s) for atrial fibrillation

Intervention

Early recurrence of atrial tachycardia (ERAT) within a 3-month blanking period after ablation

Comparator

No early recurrence of atrial tachycardia (ERAT)

Outcome

Late recurrence of atrial fibrillation or atrial tachycardiahard clinical

Early recurrence of atrial tachycardia within 3 months of AF ablation strongly predicts late recurrence of atrial arrhythmias, particularly in patients with inducible arrhythmias post-ablation or those undergoing CTI ablation.

Main Result

Absolute Event Rate: 41.1% vs 11.8%

p-value: p=<0.001

Abstract

BACKGROUND: atrial tachycardia (AT) commonly recurs within 3 months after radiofrequency catheter ablation for atrial fibrillation (AF). However, it remains unclear whether early recurrence of atrial tachycardia (ERAT) predicts late recurrence of AF or AT. METHODS: of 352 consecutive patients who underwent circumferential pulmonary vein isolation with or without linear ablation(s) for AF, 56 patients (15.9%) with ERAT were identified by retrospective analysis. ERAT was defined as early relapse of AT within a 3-month blanking period after ablation. RESULTS: during 21.7 ± 12.5 months, the rate of late recurrence was higher in patients with ERAT (41.1%) compared with those without ERAT (11.8%, P < 0.001). In a multivariable model, positive inducibility of AF or AT immediately after ablation (65.2% vs 36.4%, P = 0.046; odd ratio, 3.9; 95% confidence interval, 1.0-14.6) and the number of patients who underwent cavotricuspid isthmus (CTI) ablation (73.9% vs 42.4%, P = 0.042; odd ratio, 4.5; 95% confidence interval, 1.1-19.5) were significantly related to late recurrence in the ERAT group. The duration of ablation (174.3 ± 62.3 vs 114.7 ± 39.5 minutes, P = 0.046) and the procedure time (329.3 ± 83.4 vs 279.2 ± 79.7 minutes, P = 0.027) were significantly longer in patients with late recurrence than in those without late recurrence following ERAT. CONCLUSIONS: the late recurrence rate is higher in the patients with ERAT compared with those without ERAT following AF ablation, and is more often noted in the patients who underwent CTI ablation and had a prolonged procedure time. Furthermore, inducibility of AF or AT immediately after ablation independently predicts late recurrence in patients with ERAT.