Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?

Popa, Miruna A; Kottmaier, Marc; Risse, Elena; Telishevska, Marta; Lengauer, Sarah; Wimbauer, Katharina; Brkic, Amir; Kantenwein, Verena; Ulrich, Stephanie; Kornmayer, Marielouise; Krafft, Hannah; Hofmann, Monika; Kathan, Susanne; Reents, Tilko; Deisenhofer, Isabel; Hessling, Gabriele; Bourier, Felix

doi:10.1007/s00392-021-01934-8

2022

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Title:: Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?
Document type:: Journal Article
Author(s):: Popa, Miruna A; Kottmaier, Marc; Risse, Elena; Telishevska, Marta; Lengauer, Sarah; Wimbauer, Katharina; Brkic, Amir; Kantenwein, Verena; Ulrich, Stephanie; Kornmayer, Marielouise; Krafft, Hannah; Hofmann, Monika; Kathan, Susanne; Reents, Tilko; Deisenhofer, Isabel; Hessling, Gabriele; Bourier, Felix
Abstract:: 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.
Journal title abbreviation:: Clin Res Cardiol
Year:: 2022
Journal volume:: 111
Journal issue:: 1
Pages contribution:: 85-95
Fulltext / DOI:: doi:10.1007/s00392-021-01934-8
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/34519875
Print-ISSN:: 1861-0684
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2022