Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?,Clinical Research in Cardiology

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Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-09-14 , DOI: 10.1007/s00392-021-01934-8
Miruna A. Popa ₁ , Marc Kottmaier ₁ , Elena Risse ₁ , Marta Telishevska ₁ , Sarah Lengauer ₁ , Katharina Wimbauer ₁ , Amir Brkic ₁ , Verena Kantenwein ₁ , Stephanie Ulrich ₁ , Marielouise Kornmayer ₁ , Hannah Krafft ₁ , Monika Hofmann ₁ , Susanne Kathan ₁ , Tilko Reents ₁ , Isabel Deisenhofer ₁ , Gabriele Hessling ₁ , Felix Bourier ₁

Affiliation

Background

Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF.

Methods

The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs.

Results

ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184–45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003–0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates.

Conclusion

ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies.

Graphic abstract

中文翻译：

持续性房颤导管消融后早期心律失常复发：是否预示晚期复发？

背景

房颤 (AF) 射频导管消融 (RFCA) 后房性快速性心律失常 (ERAT) 的早期复发很常见，但其在持续性 AF 患者中的临床意义尚不清楚。我们试图确定 ERAT 对持续性 AF 的 RFCA 后节律结果的预测价值。

方法

该研究包括 207 名接受新肺静脉隔离（± 心房基质消融）的持续性和长期持续性 AF 患者（平均年龄 66.4 ± 10.7 岁，男性 66.2%）。所有患者均未服用抗心律失常药物。ERAT 定义为前 30 天内发生的任何≥ 30 s 的房性心律失常。使用 7 天动态心电图在消融后 1、3、6 和 12 个月的随访期间确定晚期复发 (LR)。

结果

ERAT 发生在 143/207 (69.1%) 例房颤 (60%) 或房性心动过速 (40%) 患者中，并且在 82% 的病例中持续存在。在 22.2 个月的中位随访期间，有 ERAT 的患者的 LR 发生率明显高于无 ERAT 的患者（92.3 对 43.8%，P < 0.001）。LR 的唯一独立预测因子是 ERAT（OR 16.8，95% CI 6.184–45.797，P < 0.001）和术中终止窦性心律（OR 0.052，95 % CI 0.003–0.851，P = 0.038）。将空白期从 30 天延长到 90 天不会影响 LR 率。