Key result
Prior failed catheter ablation linked to ~92% higher atrial tachyarrhythmia recurrence after thoracoscopic ablation.
Why the study?
Data conflict on whether prior catheter ablation worsens long-term outcomes after thoracoscopic ablation for AF, creating uncertainty about its true impact on efficacy and safety.
Does a history of failed catheter ablation reduce the efficacy of thoracoscopic ablation in patients with atrial fibrillation?
Cohort (n=150)
Does a history of failed catheter ablation reduce the efficacy of thoracoscopic ablation in patients with atrial fibrillation?
Effect estimate: HR 1.917 (95% CI 1.913-4.098)
Absolute Event Rate: 61.5% vs 77.5%
p-value: p=0.042
Previous unsuccessful pulmonary vein catheter ablation is associated with a nearly twofold increased risk of atrial tachyarrhythmia recurrence following thoracoscopic ablation.
History of failed catheter ablation was associated with higher recurrence after thoracoscopic ablation; hypothesis-generating and leaves open optimal patient selection.
Highlights Despite the widespread use of thoracoscopic ablations in the treatment of atrial fibrillation, accurate predictors of recurrent arrhythmia have not been established, therefore, the effectiveness of this procedure varies significantly (from 38 to 83%). According to clinical guidelines, thoracoscopic ablation should be considered in patients after primary catheter ablation. Several studies have noted that patients with a catheter ablation in history have a significantly higher risk of recurrent atrial fibrillation after thoracoscopic ablation compared with patients without catheter ablation in the 5-year follow-up period. However, our study results indicated similar prevalence of recurrent arrhythmia in patients with and without catheter ablation. Taking into account all of the above, we have evaluated the impact of previous catheter ablations on the effectiveness of thoracoscopic ablation of atrial fibrillation in the long-term follow-up period. Aim. To assess the impact of failed pulmonary vein catheter ablation (CA) on the efficacy and safety of thoracoscopic ablation (TSA) in the long-term follow-up period. Material and Methods. “Box lesion” TSA with left atrial auricle (LAA) exclusion was performed in 47 patients with CA in history and 103 patients without CA. The procedure was considered effective in the absence on 24-h HM ECG of any atrial tachyarrhythmia of more than 30 seconds duration recorded at the examination checkpoints. Results. The efficiency of TSA in the group with CA was 61,5% and 77,5% in the group without CA, with a mean follow-up period of 2,6 ± 0,83 years. Univariate and multivariate Cox proportional hazards analyses showed that prior CA statistically significantly increased the risks of atrial tachyarrhythmia recurrence by 1,936-fold (95% CI 1,931–4,026, p = 0,037) and 1,917-fold (95% CI 1,913–4,098, p = 0,042), respectively. Conclusion. The study results revealed that previous unsuccessful pulmonary vein CA may reduce the effectiveness of TSA in the long-term follow-up period. However, this topic requires further research involving multivariate analysis on a larger cohort of patients.
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Стребкова et al. (2024) conducted a cohort in Atrial fibrillation (n=150). Prior failed pulmonary vein catheter ablation vs. No prior catheter ablation was evaluated on Absence of any atrial tachyarrhythmia >30 seconds on 24-h Holter ECG (HR 1.917, 95% CI 1.913-4.098, p=0.042). Prior failed catheter ablation significantly increased the risk of atrial tachyarrhythmia recurrence after thoracoscopic ablation (HR 1.917; 95% CI 1.913-4.098; p=0.042).
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