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

Zink, Matthias Daniel and Chua, Winnie and Zeemering, Stef and di Biase, Luigi and Antoni, Bayes de Luna and David, Callans and Hindricks, Gerhard and Haeusler, Karl Georg and Al-Khalidi, Hussein R and Piccini, Jonathan P and Mont, Lluís and Nielsen, Jens Cosedis and Escobar, Luis Alberto and de Bono, Joseph and Van Gelder, Isabelle C and de Potter, Tom and Scherr, Daniel and Themistoclakis, Sakis and Todd, Derick and Kirchhof, Paulus and Schotten, Ulrich (2020) Predictors of recurrence of atrial fibrillation within the first 3 months after ablation. 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. ISSN 1532-2092.

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Official URL: https://academic.oup.com/europace/article-abstract...

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, https://clinicaltrials.gov/ct2/show/NCT02227550?term=NCT02227550.&rank=1.

Item Type: Article
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Cardiology
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Depositing User: Mrs Yolande Brookes
Date Deposited: 31 Jul 2020 13:41
Last Modified: 31 Jul 2020 13:41
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3330

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