Key result
Late early recurrence of atrial tachyarrhythmia (31-90 days post-ablation) was strongly associated with an increased risk of late recurrence and poor left atrial reverse remodeling.
Why the study?
Both early recurrence of atrial tachyarrhythmia and left atrial reverse remodeling during the blanking period are associated with late recurrence, but their mutual association after non-paroxysmal AF ablation was unknown.
Does the timing of early recurrence of atrial tachyarrhythmia predict left atrial reverse remodeling and late recurrence in patients undergoing non-paroxysmal AF ablation?
Cohort (n=330)
No
Does the timing of early recurrence of atrial tachyarrhythmia predict left atrial reverse remodeling and late recurrence in patients undergoing non-paroxysmal AF ablation?
Early recurrence of atrial tachyarrhythmia occurring late in the blanking period (31-90 days) after non-paroxysmal AF ablation is a strong predictor of poor left atrial reverse remodeling and late recurrence, suggesting the presence of residual arrhythmogenic substrate.
Answers are grounded in this paper and cite their sources.
Late-ERAT signals higher late recurrence risk and poor remodeling after non-paroxysmal AF ablation; hypothesis-generating for intensified monitoring and targeted trials.
Early recurrence of atrial tachyarrhythmia (ERAT) during a 90-day blanking period (BP) often occurs after atrial fibrillation (AF) ablation. Left atrial reverse remodeling (LARR), which is the reduction in LA volume (LAV), also occurs during the BP. Both ERAT and LARR are associated with late recurrence (LR, greater than 90 days after ablation). We investigated the association between ERAT and LARR following non-paroxysmal AF (NPAF) ablation. We retrospectively reviewed 330 consecutive patients undergoing initial NPAF ablation (median follow-up: 4.0 years). Based on the timing of the final ERAT, we divided the patients into No-ERAT (N = 154, without ERAT), Early (N = 39, 0–7 days after ablation), Intermediate (N = 67, 8–30), and Late-ERAT (N = 70, 31–90) groups. We assessed the extent of LARR, defined as the percentage of decrease in LAV (%ΔLAV). The %ΔLAV cutoff value was determined by receiver operating characteristic analysis, and incorporated into a multivariate analysis to assess the association between ERAT and LARR. Late-ERAT was associated with LR (hazard ratio: 6.31, 95% confidence interval (CI): 4.21–9.47, p = 0.0001). The %ΔLAV in the Late-ERAT group was significantly smaller than the other groups (p < 0.0001). The predictive power of %ΔLAV for LR was slight (AUC, 0.604; best cutoff, 18.8% decrease; p = 0.0011). In the multivariate logistic regression analysis, Late-ERAT was associated with poor LARR (%ΔLAV < 18.8% decrease) (odds ratio, 0.13; 95%CI, 0.06–0.27; p < 0.001), whereas Early- and Intermediate-ERAT did not show any correlation. Late-ERAT was strongly associated with poor LARR after NPAF ablation. Both Late-ERAT and poor LARR might reflect a residual arrhythmogenic substrate causing LR.
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Oka et al. (2020) conducted a cohort in Non-paroxysmal atrial fibrillation (n=330). Late early recurrence of atrial tachyarrhythmia (Late-ERAT, 31-90 days) vs. No early recurrence (No-ERAT) was evaluated on Late recurrence of atrial tachyarrhythmia (>90 days after ablation) (HR 6.31, 95% CI 4.21-9.47, p=0.0001). Late early recurrence of atrial tachyarrhythmia (31-90 days post-ablation) was strongly associated with an increased risk of late recurrence and poor left atrial reverse remodeling.
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