Key result
Ablation in sinus rhythm was associated with fewer acute procedure-related complications than ablation in atrial fibrillation among patients with persistent AF (4.6% vs 9.1%, p=0.012).
Why the study?
The impact of basic atrial rhythm (sinus rhythm vs AF) during AF ablation on efficacy and safety is unknown.
Does the basic atrial rhythm (sinus rhythm vs. atrial fibrillation) during first-time AF ablation affect long-term rhythm outcomes and safety?
Cohort (n=3,375)
Yes
Does the basic atrial rhythm (sinus rhythm vs. atrial fibrillation) during first-time AF ablation affect long-term rhythm outcomes and safety?
While basic atrial rhythm during AF ablation does not impact long-term rhythm success, performing ablation during sinus rhythm in patients with persistent AF is associated with a better acute and long-term safety profile.
May support sinus rhythm ablation to lower acute complications in persistent AF; leaves open confirmation in randomized trials.
BACKGROUND: The impact of basic atrial rhythm (sinus rhythm [SR] vs. atrial fibrillation [AF]) during AF ablation on efficacy and safety is unknown. METHODS: About 3375 patients from the German Ablation Registry undergoing first-time AF ablation were divided according to the type of AF and the basic atrial rhythm during the ablation procedure: paroxysmal AF (PAF) and SR [group Ia], PAF and AF [group Ib]), persistent AF and SR (IIa), and persistent AF and AF (IIb). RESULTS: Patients in SR (n = 2312 [67%]) underwent cryoballoon ablation more often (Ia vs. Ib p = .002 and IIa vs. IIb p = .010, whereas in patients in AF (n = 1063 [33%]) radiofrequency (RF)-based ablation (Ia vs. Ib p = .006 and IIa vs. IIb p = .014) including left and/or right atrial substrate modification was more frequently performed. Depending on the basic rhythm there was no difference regarding arrhythmia recurrence during long-term follow-up. For patients suffering from persistent AF acute procedure-related complications were more often documented when ablated in AF (9.1% vs. 4.6%, p = .012). which was mainly driven by the higher occurrence of pericardial effusion/tamponade. For patients suffering from persistent AF, favorable results were found regarding 366-day Kaplan-Meier estimates of the incidence of MACCE (death, myocardial infarction, and stroke; p = .011) and the composite endpoint of death, myocardial infarction, stroke, and major bleeding (p = .006), when ablated in SR. CONCLUSION: Basic atrial rhythm at the time of AF ablation did not affect long-term rhythm outcome. For patients suffering from persistent AF a more favorable acute and long-term safety profile was observed when ablated in SR.
No takes yet. Share an insight, caveat, or question.
Rottner et al. (2021) conducted a cohort in Atrial fibrillation (n=3,375). Sinus rhythm during ablation vs. Atrial fibrillation during ablation was evaluated on Acute procedure-related complications in patients with persistent AF (p=.012). Ablation in sinus rhythm was associated with fewer acute procedure-related complications than ablation in atrial fibrillation among patients with persistent AF (4.6% vs 9.1%, p=0.012).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: