Comparison of Radiofrequency Catheter Ablation Between Asymptomatic and Symptomatic Persistent Atrial Fibrillation: A Propensity Score Matched Analysis

Abstract

and ‡Duke-NUS Graduate Medical School, Singapore RFCA for Asymptomatic Persistent AF. Background: Whether patients with asymptomatic atrial fibrillation (AF) could benefit from radiofrequency catheter ablation (RFCA) remains unclear. This study aimed to compare the outcomes of RFCA between asymptomatic and symptomatic AF.Methods: Sixty-six patients with asymptomatic persistent AF who underwent the primary ablation for AF were enrolled; 132 patients with symptomatic persistent AF were matched using propensity score matching. All patients underwent circumferential pulmonary vein isolation in combination with linear ablation using AF termination as the primary procedural endpoint.Results: Sinus rhythm (SR) was restored by ablation in 18 (27.3%) patients in the asymptomatic group and 93 (70.5%) in the symptomatic group (P < 0.001). Combined with intravenous infusion of ibutilide (1 mg), the numbers were 45 (68.2%) and 116 (87.8%), respectively (P = 0.001). At 1-year follow-up, SR was present in 23 (34.8%) patients in the asymptomatic group and 78 (59.1%) in the symptomatic group without any antiarrhythmic medication after a single procedure (P = 0.001). Of the 43 patients experiencing recurrence in the asymptomatic group, 16 (37.2%) had recurrent atrial tachycardia (AT)-related symptoms. Multivariate analysis showed that asymptomatic AF was independently associated with AF failed to be terminated by ablation (OR: 7.1; 95% CI: 3.4 to 14.9; P < 0.001) and recurrence (OR: 2.2; 95% CI: 1.1 to 4.4; P = 0.018). Patients with asymptomatic AF showed less improvement in quality of life postablation than those with symptoms.Conclusion: Current catheter ablation techniques showed worse outcomes in asymptomatic AF patients than in those with symptoms. Recurrent AT could cause significant symptoms in previously asymptomatic

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

“… IIa C-LD 370–372 Asymptomatic AF ∗∗ Paroxysmal: Catheter ablation may be considered in select patients. ∗∗ IIb C-EO 416 , 418 Persistent: Catheter ablation may be considered in select patients. IIb C-EO 417 Indications for surgical ablation of atrial fibrillation C. Indications for concomitant open (such as mitral valve) surgical ablation of atrial fibrillation Symptomatic AF refractory or intolerant to at least one Class I or III antiarrhythmic medication Paroxysmal: Surgical ablation is recommended.…”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary

“… IIa C-LD 27 , 28 , 65 Asymptomatic AF ∗∗ Paroxysmal: Catheter ablation may be considered in select patients. ∗∗ IIb C-EO 66 , 67 Persistent: Catheter ablation may be considered in select patients. IIb C-EO 68 Indications for surgical ablation of atrial fibrillation C. Indications for concomitant open (such as mitral valve) surgical ablation of atrial fibrillation Symptomatic AF refractory or intolerant to at least one Class I or III antiarrhythmic medication Paroxysmal: Surgical ablation is recommended.…”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary

“…Indications for catheter atrial fibrillation ablation in populations of patients not well represented in clinical trials  Congestive heart failureIt is reasonable to use similar indications for AF ablation in selected patients with heart failure as in patients without heart failure.IIaB-R[36–52]  Older patients (>75 years of age)It is reasonable to use similar indications for AF ablation in selected older patients with AF as in younger patients.IIaB-NR[53–59]  Hypertrophic cardiomyopathyIt is reasonable to use similar indications for AF ablation in selected patients with HCM as in patients without HCM.IIaB-NR[60–62]  Young patients (<45 years of age)It is reasonable to use similar indications for AF ablation in young patients with AF (<45 years of age) as in older patients.IIaB-NR[63, 64]  Tachy-brady syndromeIt is reasonable to offer AF ablation as an alternative to pacemaker implantation in patients with tachy-brady syndrome.IIaB-NR[33–35]  Athletes with AFIt is reasonable to offer high-level athletes AF as first-line therapy due to the negative effects of medications on athletic performance.IIaC-LD[27, 28, 65]  Asymptomatic AF ∗∗ Paroxysmal: Catheter ablation may be considered in select patients. ∗∗ IIbC-EO[66, 67]Persistent: Catheter ablation may be considered in select patients.IIbC-EO[68]Indications for surgical ablation of atrial fibrillation C. Indications for concomitant open (such as mitral valve) surgical ablation of atrial fibrillation  Symptomatic AF refractory or intolerant to at least one Class I or III antiarrhythmic medicationParoxysmal: Surgical ablation is recommended.IB-NR[69–82]Persistent: Surgical ablation is recommended.IB-NR[69–82]Long-standing persistent: Surgical ablation is recommended.IB-NR[69–82]  Symptomatic AF prior to i...…”