Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry

Abstract

Catheter ablation (CA) for atrial fibrillation (AF) has emerged as a widespread first or second line treatment option. However, up to 45% of patients (pts) show recurrence of AF within 12 month after CA. We present prospective multicenter registry data comparing characteristics of pts with and without recurrence of AF within the first year after CA. This study comprises all pts with complete follow-up one year after CA (1-y-FU; n = 3679). During 1y-FU in 1687 (45.9%) pts recurrence of AF occurred. The multivariate analysis revealed female sex and AF type prior to the procedure as predictors for AF recurrence. Furthermore, comorbidities such as valvular heart disease and renal failure as well as an early AF relapse were also predictors of AF recurrence during 1-y-FU. However, despite an AF recurrence rate of 45.9%, the majority of these pts (72.4%) reported a significant alleviation of clinical symptoms. In conclusion in pts with initially successful CA for AF female sex, AF type, in-hospital AF relapse and comorbidities such as renal failure and valvular heart disease are independent predictors for AF recurrence during 1-y-FU. However, the majority of pts deemed their interventions as successful with significant reduction of symptoms irrespective of AF.

Recurrent atrial fibrillation/flutter detection after ablation or cardioversion using the AliveCor KardiaMobile device: iHEART results

“…The prevalence of AF will surge in the next decade due to an aging population that is living longer with a high burden of comorbid conditions that are associated with AF . Catheter radiofrequency ablation (RFA) is one form of therapy widely used in clinical practice to treat symptomatic AF, but postprocedure recurrent AF occurs in 20% to 45% of patients . Direct current cardioversion (DCCV) interrupts AF and restores sinus rhythm, but has no durable effect.…”

Additional cavotricuspid isthmus block ablation may not improve the outcome of atrial fibrillation ablation

“…Therefore, CTI block ablation is frequently performed in addition to left atrial (LA) ablation. The recurrence rate of AF was still significantly high after the first pulmonary vein isolation (PVI) by catheter ablation of AF, especially in patients with larger LA volume, prior non‐paroxysmal AF, in‐hospital AF relapse, impaired cardiac and renal function, and in female patients . A previous study reported that an LA volume greater than 145 mL was a predictor of atrial arrhythmia recurrence, even when adjusted for the effect of age, gender, body mass index, hypertension, and type of AF .…”

Influence of risk factors in the ESC‐EHRA EORP atrial fibrillation ablation long‐term registry

“…The impact of risk factors on repeat ablation procedures has not been studied extensively. The above‐mentioned German registry found no differences in age, gender, or risk factors between patients with AF recurrence who did or did not undergo a repeat procedure . It has to be noted, however, that only 47.5% of patients with AF recurrence underwent a repeat procedure, which may be related to the short duration of the AF episodes that was defined as recurrence.…”

“…The relationship between risk factors and AF recurrence has been studied before in a German multicenter registry of 3679 patients with 1‐year follow‐up after ablation . Recurrence rate was 45.9% and female sex (OR 1.27; 95% CI 1.11–1.46), valvular heart disease (OR 1.29; 95% CI 1.02–1.63), heart failure (OR 1.58; 95% CI 1.36‐1.84), and renal failure (OR 3.35; CI 1.08–10.41) significantly predicted AF recurrence during 1‐year follow‐up.…”