Key result
Maintaining sinus rhythm ≥24 hours after DC cardioversion predicts ~55% lower AF recurrence post-ablation.
Why the study?
The efficacy of pre-ablation direct current cardioversion in patients with persistent atrial fibrillation remains controversial, and its ability to predict catheter ablation outcomes was evaluated.
Does maintenance of sinus rhythm after pre-ablation DC cardioversion predict reduced recurrence of atrial fibrillation after catheter ablation in patients with persistent AF?
Cohort (n=383)
Does maintenance of sinus rhythm after pre-ablation DC cardioversion predict reduced recurrence of atrial fibrillation after catheter ablation in patients with persistent AF?
Effect estimate: HR 0.45 (95% CI 0.21-0.99)
Absolute Event Rate: 61.5% vs 38.3%
p-value: p=0.047
Successful maintenance of sinus rhythm for 24 hours after pre-ablation DC cardioversion independently predicts long-term freedom from atrial fibrillation following catheter ablation in patients with persistent AF.
Maintenance of sinus rhythm after pre-ablation DC cardioversion was associated with lower post-ablation AF recurrence; hypothesis-generating and requires prospective validation before guiding patient selection.
The efficacy of direct current (DC) cardioversion before catheter ablation (CA) for persistent atrial fibrillation (PerAF) patients remains controversial. We hypothesized that maintenance of sinus rhythm (SR) by pre-ablation DC cardioversion may predict the outcome of CA in patients with PerAF. A total of 383 PerAF patients with no or mild symptoms (EHRA I/II) who had undergone DC cardioversion before CA (301 males, 65 ± 10 years old, mean atrial fibrillation (AF) duration: 25 ± 47 months) were retrospectively enrolled. Whether or not SR was maintained at least 24 hour after DC cardioversion, patients were divided into two groups, namely, the DC-SR group and DC-AF group, and then all were followed until AF recurrence after CA. After DC cardioversion, 281 (73%) patients were categorized into the DC-SR group, and 102 (27%) were categorized into the DC-AF group. A total of 195 patients underwent CA at an average of 83 (54-145) days after DC cardioversion, including 161 (83%) in the DC-SR group and 34 (17%) in the DC-AF group. During follow-up (median: 15 [10-25] months), the number of patients who were free from AF was significantly higher in the DC-SR group compared with the DC-AF group (61.5% versus 38.3%, P < 0.0001). Multivariate analysis revealed that the DC-SR group (hazard ratio [HR]: 0.45, 95% confidence interval [CI]: 0.21-0.99, P = 0.047) and age at first AF diagnosis (HR: 0.95, 95% CI: 0.91-1.00, P = 0.039) were the independent predictors for being AF-free after CA. In conclusion, the 24-hour rhythm outcome of pre-ablation DC cardioversion and age at first AF diagnosis may predict the recurrence of AF after CA in patients with PerAF.
No takes yet. Share an insight, caveat, or question.
Kamada et al. (2022) conducted a cohort in Persistent atrial fibrillation (PerAF) (n=383). Maintenance of sinus rhythm ≥24 hours after pre-ablation DC cardioversion (DC-SR) vs. Failure to maintain sinus rhythm ≥24 hours after DC cardioversion (DC-AF) was evaluated on Freedom from atrial fibrillation recurrence after catheter ablation (HR 0.45, 95% CI 0.21-0.99, p=0.047). Maintenance of sinus rhythm for ≥24 hours after pre-ablation DC cardioversion independently predicted higher freedom from AF recurrence after catheter ablation (HR 0.45; 95% CI 0.21-0.99; P=0.047).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: