Key result
Persistent AF is linked to ~68% higher risk of post-ablation recurrence.
Why the study?
Catheter ablation for AF is superior to antiarrhythmic medication, but long-term AF recurrence post-ablation remains common, prompting evaluation of predictors of long-term recurrence.
What are the baseline and procedural predictors of long-term atrial fibrillation recurrence in patients undergoing catheter ablation for atrial fibrillation?
Cohort (n=1,061)
Yes
What are the baseline and procedural predictors of long-term atrial fibrillation recurrence in patients undergoing catheter ablation for atrial fibrillation?
In this multicenter UK cohort of patients undergoing AF ablation, persistent AF subtype and left atrial dilatation independently predicted long-term arrhythmia recurrence, whereas periprocedural amiodarone use was associated with lower recurrence rates across all AF subtypes.
May guide risk stratification before AF ablation; leaves open whether targeted strategies improve outcomes in these subgroups.
Background Catheter ablation for atrial fibrillation (AF) is superior to antiarrhythmic medication, but long-term AF recurrence post-AF ablation remains common. Purpose Evaluate predictors of AF recurrence at long-term follow-up post-ablation. Methods Retrospective cohort study of all consecutive AF ablation procedures performed across four UK AF ablation hospitals between Jan 2018-June 2023. Baseline characteristics (including AF subtype/comorbidities/medications), procedural details/complications were collected. Atrial arrhythmia recurrences during follow-up were noted. Multivariate Cox regression was used to identify predictors of recurrence. Results A total of 1,061 patients underwent 1,155 ablation procedures. Mean age was 63±11years with 393 (37%) females. Paroxysmal AF (PAF) was present in 592 (55.8%) and persistent AF (including long-standing persistent AF) in 469 (44.2%). Hypertension, diabetes, and coronary disease were present in 42.2%, 11.6%, and 9.5% respectively. Most (81.5%) had preserved left ventricular ejection fraction, and 58.2% had non-dilated left atria (LA). Cryoballoon ablation was performed in 79.3%, with the remainder undergoing radio-frequency point-by-point ablation; 219 (19%) were redo AF-ablations. The median follow-up duration was 3.3 years (IQR:1.8–5.1 years). AF recurrence rates were 23.7%, 39.2% and 73.6% at 1-, 2- and 5-years, respectively. AF subtype (persistent AF hazard ratio (HR):1.68; long-standing persistent AF HR:2.23, both p<0.001) and severe LA dilatation (HR:1.45, p=0.003) independently predicted recurrence in the total AF cohort. Moderate and severe LA dilatation were independent predictors of recurrence only in persistent AF (HR:1.58, p=0.01 and HR:1.64, p<0.001, respectively), while amiodarone use at time of AF ablation predicted reduced atrial arrhythmia recurrence in both PAF (HR:0.49, p=0.04) and persistent AF (HR:0.74, p=0.02). Conclusions AF subtype and baseline LA volume were independent predictors of AF recurrence at long-term follow-up. Moderate-to-severe LA dilatation predicted recurrence in persistent AF but not PAF. Early post-procedure use of amiodarone lowered atrial arrhythmia recurrence irrespective of AF subtype.
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Chandan et al. (2026) conducted a cohort in Atrial fibrillation (n=1,061). Persistent AF and severe left atrial dilatation vs. Paroxysmal AF and non-dilated left atrium was evaluated on Atrial fibrillation / atrial arrhythmia recurrence (HR 1.68, p=<0.001). Persistent AF (HR 1.68, p<0.001) and severe LA dilatation (HR 1.45, p=0.003) independently predicted post-ablation AF recurrence, which reached 73.6% at 5 years.
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