November 1, 2006Journal of Cardiovascular Electrophysiology
Incidence and Predictors of Very Late Recurrence of Atrial Fibrillation After Ablation
Key result
Very late recurrence of atrial fibrillation after ablation was associated with weight >200 lbs, fewer isolated pulmonary veins, and the presence of non-PV triggers (OR 3.4; 95% CI 1.3-8.7; P=0.01).
Why the study?
What are the clinical and procedural predictors of very late recurrence of atrial fibrillation after radiofrequency catheter ablation?
Population
246 patients who underwent radiofrequency catheter ablation for refractory atrial fibrillation at the…
Comparison
Patients with very late recurrence of AF vs Patients without recurrence of AF and ≥12 months…
Design
Case-control
Follow-up
≥12 months
Authors
Discussion
Loading...
Member takes
Implication
May inform pre-ablation weight counseling; hypothesis-generating for non-PV triggers and requires prospective validation.
Key Points
- To identify patient characteristics and predictors associated with very late recurrence of atrial fibrillation after ablation.
- Nested case-control study comparing patients with and without very late AF recurrence after ablation.
- Patients underwent isolation of pulmonary veins and elimination of non-PV triggers during procedure.
- Analysis included 27 patients with very late recurrence and 219 without, all with at least 12 months of follow-up.
- Patients with very late recurrence had higher rates of non-PV triggers (30% vs 11%, OR 3.4, 95% CI 1.3-8.7, P = 0.01).
- Less frequent right inferior PV isolation in recurrence group (37% vs 61%, P = 0.02).
- Majority showed PV reconnectivity and new triggers during repeat ablation.
Study Design
Type
Case-Control (n=246)
Multicenter
No
Structured PICO
What are the clinical and procedural predictors of very late recurrence of atrial fibrillation after radiofrequency catheter ablation?
P
Population
246 patients who underwent radiofrequency catheter ablation for refractory atrial fibrillation at the University of Pennsylvania, including 27 with very late recurrence (≥12 months post-ablation) and 219 without recurrence and ≥12 months of follow-up. Mean age 54.6 ± 11.3 years, 79% men.
I
Intervention
Patients with very late recurrence of AF (≥12 months post-ablation)
C
Comparator
Patients without recurrence of AF and ≥12 months of follow-up
O
Outcome
Very late recurrence of atrial fibrillation (≥12 months post-ablation)hard clinical
Main Result
Effect estimate: OR 3.4 (95% CI 1.3-8.7)
Absolute Event Rate: 30% vs 11%
p-value: p=0.01
Very late recurrence of atrial fibrillation after ablation is associated with higher body weight, presence of non-pulmonary vein triggers, and incomplete pulmonary vein isolation during the initial procedure.
Cite This Study
Mainigi et al. (2006) conducted a case-control in Atrial fibrillation (n=246). Very late AF recurrence (≥12 months post-ablation) vs. No recurrence was evaluated on Presence of non-pulmonary vein triggers during initial ablation (OR 3.4, 95% CI 1.3-8.7, p=0.01). Very late recurrence of atrial fibrillation after ablation was associated with weight >200 lbs, fewer isolated pulmonary veins, and the presence of non-PV triggers (OR 3.4; 95% CI 1.3-8.7; P=0.01).