Key result
Radiofrequency catheter ablation in asymptomatic persistent AF resulted in lower rates of sinus rhythm restoration compared to symptomatic AF (27.3% vs 70.5%, P<0.001).
Why the study?
Does radiofrequency catheter ablation yield different procedural and long-term outcomes in asymptomatic versus symptomatic persistent atrial fibrillation?
Cohort (n=198)
Does radiofrequency catheter ablation yield different procedural and long-term outcomes in asymptomatic versus symptomatic persistent atrial fibrillation?
Effect estimate: OR 7.1 (95% CI 3.4 to 14.9)
Absolute Event Rate: 27.3% vs 70.5%
p-value: p=<0.001
Catheter ablation for asymptomatic persistent atrial fibrillation results in lower procedural success, higher 1-year recurrence, and less quality of life improvement compared to symptomatic patients, while potentially introducing new arrhythmia-related symptoms.
Ablation success appears lower in asymptomatic persistent AF; leaves open its net benefit and optimal use versus symptomatic cases.
BACKGROUND: Whether patients with asymptomatic atrial fibrillation (AF) could benefit from radiofrequency catheter ablation (RFCA) remains unclear. This study aimed to compare the outcomes of RFCA between asymptomatic and symptomatic AF. METHODS: Sixty-six patients with asymptomatic persistent AF who underwent the primary ablation for AF were enrolled; 132 patients with symptomatic persistent AF were matched using propensity score matching. All patients underwent circumferential pulmonary vein isolation in combination with linear ablation using AF termination as the primary procedural endpoint. RESULTS: Sinus rhythm (SR) was restored by ablation in 18 (27.3%) patients in the asymptomatic group and 93 (70.5%) in the symptomatic group (P < 0.001). Combined with intravenous infusion of ibutilide (1 mg), the numbers were 45 (68.2%) and 116 (87.8%), respectively (P = 0.001). At 1-year follow-up, SR was present in 23 (34.8%) patients in the asymptomatic group and 78 (59.1%) in the symptomatic group without any antiarrhythmic medication after a single procedure (P = 0.001). Of the 43 patients experiencing recurrence in the asymptomatic group, 16 (37.2%) had recurrent atrial tachycardia (AT)-related symptoms. Multivariate analysis showed that asymptomatic AF was independently associated with AF failed to be terminated by ablation (OR: 7.1; 95% CI: 3.4 to 14.9; P < 0.001) and recurrence (OR: 2.2; 95% CI: 1.1 to 4.4; P = 0.018). Patients with asymptomatic AF showed less improvement in quality of life postablation than those with symptoms. CONCLUSION: Current catheter ablation techniques showed worse outcomes in asymptomatic AF patients than in those with symptoms. Recurrent AT could cause significant symptoms in previously asymptomatic patients.
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WU et al. (2016) conducted a cohort in Persistent Atrial Fibrillation (n=198). Radiofrequency catheter ablation vs. Symptomatic persistent AF was evaluated on AF termination (OR 7.1, 95% CI 3.4 to 14.9, p=<0.001). Radiofrequency catheter ablation in asymptomatic persistent AF resulted in lower rates of sinus rhythm restoration compared to symptomatic AF (27.3% vs 70.5%, P<0.001).
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