Clinical recurrence of atrial fibrillation >5 years after catheter ablation was independently associated with low left atrial voltage (OR 0.61; 95% CI 0.38-0.94; P=0.032).
Cohort (n=1,417)
No
What are the predictors and mechanisms of late clinical recurrence (>5 years) after atrial fibrillation catheter ablation?
Late recurrence of AF (>5 years) after catheter ablation is associated with smaller LA volume, lower LA voltage, and higher extra-pulmonary vein triggers, suggesting progressive atrial myopathy.
Estimación del efecto: OR 0.61 (95% CI 0.38-0.94)
valor p: p=0.032
AIMS: Atrial fibrillation (AF) is a chronic progressive disease that continuously recurs even after successful AF catheter ablation (AFCA). We explored the mechanism of long-term recurrence by comparing patient characteristics and redo-ablation findings. METHODS AND RESULTS: Among the 4248 patients who underwent a de novo AFCA and protocol-based rhythm follow-up at a single centre, we enrolled 1417 patients 71.7% male, aged 60.0 (52.0-67.0) years, 57.9% paroxysmal AF who experienced clinical recurrences (CRs), and divided them according to the period of recurrence: within one year (n = 645), 1-2 years (n = 339), 2-5 years (n = 308), and after 5 years (CR>5 yr, n = 125). We also compared the redo-mapping and ablation outcomes of 198 patients. In patients with CR>5 yr, the proportion of paroxysmal AF was higher (P = 0.031); however, the left atrial (LA) volume (quantified by computed tomography, P = 0.003), LA voltage (P = 0.003), frequency of early recurrence (P 5 yr was independently associated with a low LA volume odds ratio (OR) 0.99 (0.98-1.00), P = 0.035, low LA voltage OR 0.61 (0.38-0.94), P = 0.032, and lower early recurrence [OR 0.40 (0.23-0.67), P 5 yr, despite no difference in the de novo protocol (P for trend 0.003). The rhythm outcomes of repeat ablation procedures did not differ according to the timing of the CR (log-rank P = 0.330). CONCLUSIONS: Patients with a later CR exhibited a smaller LA volume, lower LA voltage, and higher extra-pulmonary vein triggers during the repeat procedure, suggesting AF progression.
Choi et al. (Wed,) conducted a cohort in Atrial fibrillation (n=1,417). Clinical recurrence >5 years vs. Clinical recurrence ≤5 years was evaluated on Predictors of clinical recurrence >5 years (low left atrial voltage) (OR 0.61, 95% CI 0.38-0.94, p=0.032). Clinical recurrence of atrial fibrillation >5 years after catheter ablation was independently associated with low left atrial voltage (OR 0.61; 95% CI 0.38-0.94; P=0.032).