Key result
In patients undergoing multiple (≥3) catheter ablations for atrial fibrillation, freedom from atrial tachyarrhythmia recurrence was 40.7%, with recurrent AF after the second procedure independently predicting further recurrence (HR 1.88).
Why the study?
Many AF patients require more than one RFCA procedure to maintain sinus rhythm, and the risk and risk factors of ATa recurrence in patients undergoing multiple (≥3) RFCA procedures required evaluation.
Observational (n=118)
No
Effect estimate: HR 1.88 (95% CI 1.16-3.05)
p-value: p=0.010
Multiple (≥3) catheter ablation procedures for atrial fibrillation yield unsatisfactory long-term freedom from atrial tachyarrhythmia (40.7%), with recurrent AF after the second procedure predicting worse outcomes.
Multiple ablations for AF yield limited long-term success; hypothesis-generating for better selection and adjunctive strategies in prospective studies.
Abstract Background: Many atrial fibrillation (AF) patients require more than one radiofrequency catheter ablation (RFCA) procedure to maintain sinus rhythm. This study aimed to evaluate risk and risk factors of atrial tachyarrhythmia (ATa) recurrence in patients undergoing multiple (≥3) RFCA procedures for AF. Methods: This single-center, retrospective, observational study enrolled 118 consecutive patients who underwent multiple ablation procedures for paroxysmal and non-paroxysmal AF with circumferential pulmonary vein ablation (CPVA), and bidirectional block of lines with disappearance of complex fractionated atrial electrograms (CFAEs) as index procedural endpoints, respectively. Results: At a median follow-up of 18 (range, 6-91) months after the last procedure (mean, 3.2 procedures), freedom from ATa recurrence was 40.7% (48/118). Initially diagnosed non-paroxysmal AF (P=0.039), baseline LA size (P=0.044), and recurrent AF after the second procedure (P=0.044) were univariate predictors of ATa recurrence, while only the latter (P=0.010) was an independent multivariate predictor (hazard ratio for ATa recurrence of 1.88 [95% CI, 1.16-3.05]. Conversion of recurrent types between AF and AFL/AT occurred in 52.9% (37/70) of patients with ATa recurrence, and 29.2% (14/48) of patients with sinus rhythm after last procedure. Few patients (7.8% [20/257]) recovered PV potential induced recurrent ATa during multiple procedures, and most (87.6% [141/161]) were bystanders of recurrent ATa. Conclusions: Multiple (>3) RFCA for paroxysmal or non-paroxysmal AF yielded unsatisfactory ATa recurrence rates with recurrent AF after the second procedure as multivariate predictor and recovered PV potential as a bystander commonly as underlying mechanism. Conversion of recurrent types between AF and AFL/AT was common.
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Wang et al. (2019) conducted an observational in Atrial fibrillation (n=118). Multiple (≥3) radiofrequency catheter ablation procedures was evaluated on Atrial tachyarrhythmia (ATa) recurrence (predicted by recurrent AF after the second procedure) (HR 1.88, 95% CI 1.16-3.05, p=0.010). In patients undergoing multiple (≥3) catheter ablations for atrial fibrillation, freedom from atrial tachyarrhythmia recurrence was 40.7%, with recurrent AF after the second procedure independently predicting further recurrence (HR 1.88).
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