Key result
Long AF duration predicts ~80% higher late recurrence risk, improving CAAP-AF scores alongside early recurrence.
Why the study?
Recurrence after atrial fibrillation (AF) ablation remains common, prompting evaluation of AF duration and early recurrence to identify patients at high risk.
Do long AF duration and early recurrence predict late recurrence after radiofrequency catheter ablation in patients with atrial fibrillation?
Cohort (n=1,763)
No
Do long AF duration and early recurrence predict late recurrence after radiofrequency catheter ablation in patients with atrial fibrillation?
Effect estimate: HR 1.80 (95% CI 1.38-2.35)
p-value: p=<0.001
Long AF duration and early recurrence are strong independent predictors of late recurrence after AF ablation, and their addition improves the predictive performance of the CAAP-AF score.
May aid post-ablation risk stratification in AF; extends CAAP-AF but remains hypothesis-generating pending prospective validation.
Background Recurrence after atrial fibrillation (AF) ablation is still common. Objective This study aimed to evaluate the predictive abilities of AF duration and early recurrence (ER) to discriminate high-risk patients for recurrence. Methods We enrolled 1,763 consecutive patients with AF who were scheduled to receive the index radiofrequency catheter ablation (RFCA) from January 2016 to August 2021 in Dalian, China. Long AF duration (LAFD) was considered if the course of AF lasted for ≥ 12 months. ER was defined as any atrial tachycardia (AT) or AF event longer than 30 s occurring within a 3-month post-RFCA. Results Late recurrence occurred in 643 (36.5%) of the 1,763 patients at a median of 35 months after RFCA. Multivariate analysis identified LAFD (hazard ratio (HR): 1.80, 95% confidence interval (CI): 1.38–2.35, p < 0.001) and ER (HR: 2.34, 95% CI: 1.82–3.01, p < 0.001) as strong independent predictors of late recurrence in non-paroxysmal AF. Similarly, LAFD (HR: 1.48, 95% CI: 1.20–1.84, p < 0.001) and ER (HR: 3.40, 95% CI: 2.68–4.30, p < 0.001) were significantly associated with late recurrence in paroxysmal AF. Receiver operating curve analyses revealed that the CAAP-AF (CAD, Atrial diameter, Age, Persistent or longstanding AF, Antiarrhythmic drugs failed, Female) had the highest predict power [area under ROC curve (AUC) 0.586]. The addition of ER and LAFD to the CAAP-AF score significantly improved risk discrimination for late recurrence after AF ablation from 0.586 to 0.686. Conclusion Long AF duration and ER were independently associated with late recurrence. The prediction performance of the CAAP-AF model for recurrence was improved by the addition of LAFD and ER.
No takes yet. Share an insight, caveat, or question.
Li et al. (2022) conducted a cohort in Atrial fibrillation (n=1,763). Long atrial fibrillation duration (≥12 months) and early recurrence vs. Short atrial fibrillation duration and no early recurrence was evaluated on Late recurrence of atrial fibrillation in non-paroxysmal AF (LAFD predictor) (HR 1.80, 95% CI 1.38-2.35, p=<0.001). Long atrial fibrillation duration and early recurrence independently predicted late recurrence after ablation, and their addition to the CAAP-AF score improved risk discrimination from 0.586 to 0.686.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: