Clinical and Echocardiographic Risk Factors Predict Late Recurrence after Radiofrequency Catheter Ablation of Atrial Fibrillation

Abstract

The benefits of radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) significantly decrease with late recurrence (LR). We aimed to develop a scoring system to identify patients at high and low risk for LR following RFCA, based on a comprehensive evaluation of multiple risk factors for AF recurrence, including echocardiographic parameters. We studied 2,352 patients with AF undergoing first-time RFCA in a single institution. The LR-free survival rate up to 5 years was measured using a Kaplan-Meier analysis. The influence of clinical and echocardiographic parameters on LR was calculated with a Cox-regression analysis. Duration of AF ≥4 years (hazard ratio [HR] = 1.75; p < 0.001), non-paroxysmal AF (HR = 3.18; p < 0.001), and diabetes (HR = 1.34; p = 0.015) were associated with increased risk of LR. Left atrial (LA) diameter ≥45 mm (HR = 2.42; p < 0.001), E/e′ ≥ 10 (HR = 1.44; p < 0.001), dense SEC (HR = 3.30; p < 0.001), and decreased LA appendage flow velocity (≤40 cm/sec) (HR = 2.35; p < 0.001) were echocardiographic parameters associated with increased risk of LR following RFCA. The LR score based on the aforementioned risk factors could be used to predict LR (area under curve = 0.717) and to stratify the risk of LR (HR = 1.45 per 1 point increase in the score; p < 0.001). In conclusion, LR after RFCA is affected by multiple clinical and echocardiographic parameters. This study suggests that combining these multiple risk factors enables the identification of patients with AF at high or low risk for having arrhythmia recurrence.

Blood flow volume of left atrial appendage measured by magnetic resonance imaging is improved after radiofrequency catheter ablation of atrial fibrillation

“…The protocol for RFCA in our institution is described in the previous studies 19,20 . In brief, double trans‐septal punctures were performed after positioning multi‐polar catheters at the right ventricle, high right atrium, and coronary sinus.…”

Atrial fibrillation ablation in heart failure patients: improved systolic function after cryoballoon pulmonary vein isolation

“…Interestingly, recurrence of AT/AF, persistent AF, and LA enlargement also showed a trend in the univariate regression model, but they were not independent predictors of LVEF non‐improvement. It is widely accepted, that persistent AF patients and LA enlargement are associated with higher arrhythmia recurrence rates, 25 which might explain why they are not independent predictors in the multivariate regression analysis. In addition, this is perfectly in line with the results of the CASTLE‐AF trial, where only reduction in AF burden, but not recurrence any AT/AF episode correlated with reduction in HF hospitalization and mortality.…”

Revisiting Antiarrhythmic Drug Therapy for Atrial Fibrillation: Reviewing Lessons Learned and Redefining Therapeutic Paradigms

“…Importantly, even when ablation succeeds in restoring sinus rhythm, ablation causes additional inflammation and fibrosis that perpetuate the original electrical and structural remodeling caused by AF (Teh et al, 2012). After AF ablation, the atrial conduction slowing, the decrease in left atrial ejection fraction with or without atrial dilation, and the development of new ablation-induced inflammation and fibrosis (Okumura et al, 2011) indicate worsening atrial function and predict increased risk of AF recurrence (Marrouche et al, 2014;Kim et al, 2018;Kim et al, 2019). Marked atrial fibrosis and elevated levels of inflammatory markers in AF recurrences are evident both in vivo (Qu et al, 2009;Sonmez et al, 2014) and postmortem (Ito et al, 2013;Corradi et al, 2014).…”

“…Past 7 days, AF is considered sustained. Sustained AF is designated “persistent” if not lasting longer than 1 year, “longstanding persistent” if lasting longer than 1 year ( Calkins et al, 2007 ; Kirchhof et al, 2016 ), and “permanent” if rhythm control is unsuccessful or not attempted. Permanent AF is reclassified as longstanding persistent if a rhythm control strategy is adopted after 1 year of continuous AF.…”

“…In addition, AF catheter ablation faces its own host of considerable limitations, such as higher costs, limited availabilities of skilled electrophysiologists and experienced centers, procedural risks, and patients’ ablation candidacy, to name just a few. Thus, aside from patients’ own values and preferences for a pharmacological vs. non-pharmacological approach, expert consensus in both the ESC and AHA/ACC//HRS guidelines indicates a stronger class of recommendation for catheter ablation to maintain sinus rhythm in the presence of three critical variables: symptomatic recurrences, AF class (≤80% success rate for paroxysmal vs. ≤50% for persistent and longstanding persistent ) ( Kirchhof et al, 2016 ; Calkins et al, 2018 ), and heart failure (class of recommendation IIb) ( January et al, 2019 ).…”