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Predictors of recurrence of atrial fibrillation within the first 3 months after ablation.

ABSTRACT: AIMS:Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50-70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. METHODS AND RESULTS:We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA-AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90?days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14?days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93-2.6; P?=?0.11], coronary artery disease (HR 1.85, 95% CI 1.20-2.86; P?=?0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26-2.49; P?=?0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00-1.01; P?=?0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129?±?31?ms vs. 122?±?22?ms in patients without AF, P?=?0.03). CONCLUSION:Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14?days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. TRIAL REGISTRATION:Clinicaltrials.gov identifier NCT02227550.

SUBMITTER: Zink MD

PROVIDER: S-EPMC7478316 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Predictors of recurrence of atrial fibrillation within the first 3 months after ablation.

Zink Matthias Daniel MD Chua Winnie W Zeemering Stef S di Biase Luigi L Antoni Bayes de Luna BL David Callans C Hindricks Gerhard G Haeusler Karl Georg KG Al-Khalidi Hussein R HR Piccini Jonathan P JP Mont Lluís L Nielsen Jens Cosedis JC Escobar Luis Alberto LA de Bono Joseph J Van Gelder Isabelle C IC de Potter Tom T Scherr Daniel D Themistoclakis Sakis S Todd Derick D Kirchhof Paulus P Schotten Ulrich U

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 20200901 9

<h4>Aims</h4>Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50-70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation.<h4>Methods and results</h4>We retrospectively analysed data for recurrence of AF w ...[more]

PMID: 32725107

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Project description:ObjectivesThe incidence of atrial fibrillation (AF) in patients older than 75 years of age is expected to increase, and its treatment remains challenging. This study evaluated the impact of age on the outcomes of surgical ablation of AF.MethodsA retrospective review was performed of patients who underwent the Cox-maze IV procedure at a single institution between 2005 and 2017. The patients were divided into a younger (age <75 years, n = 548) and an elderly cohort (age ≥75 years, n = 148). Rhythm outcomes were assessed at 1 year and annually thereafter. Predictors of first atrial tachyarrhythmia (ATA) recurrence were determined using Fine-Gray regression, allowing for death as the competing risk.ResultsThe mean age of the elderly group was 78.5 ± 2.8 years. The majority of patients (423/696, 61%) had nonparoxysmal AF. The elderly patients had a lower body mass index (P < .001) and greater rates of hypertension (P = .011), previous myocardial infarction (P = .017), heart failure (P < .001), and preoperative pacemaker (P = .008). Postoperatively, the elderly group had a greater rate of overall major complications (23% vs 14%, P = .017) and 30-day mortality (6% vs 2%, P = .026). The percent freedom from ATAs and antiarrhythmic drugs was lower in the elderly patients at 3 (69% vs 82%, P = .030) and 4 years (65% vs 79%, P = .043). By competing risk analysis, the incidence of first ATA recurrence was greater in elderly patients (33% vs 20% at 5 years; Gray test, P = .005). On Fine-Gray regression adjusted for clinically relevant covariates, increasing age was identified as a predictor of ATAs recurrence (subdistribution hazard ratio, 1.03; 95% confidence interval, 1.02-1.05, P < .001).ConclusionsThe efficacy of the Cox-maze IV procedure was worse in elderly patients; however, the majority of patients remained free of ATAs at 5 years. The lower success rate in these greater-risk patients should be considered when deciding to perform surgical ablation.

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Predictors of recurrence of atrial fibrillation within the first 3 months after ablation.

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Predictors of recurrence of atrial fibrillation within the first 3 months after ablation.

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