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

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

Low voltage in small left atrium in patients with persistent atrial fibrillation: left atrium diameter alone is not always a predictor of atrial fibrosis or ablation prognosis Low voltage in small left atrium in atrial fibrillation

“…The ablation of PeAF in elderly women showed the worst outcomes, which indicates that women may require intervention during the early stage of AF (12)(13)(14)(15). To prevent failure of ablation and achieve better outcomes, we recommend intensive screening for AF and aggressive intervention for paroxysmal AF in elderly women.…”

A Retrospective Cohort Study on Predictors for Rehospitalizations With Recurrence of Atrial Fibrillation Post-Catheter Ablation for Atrial Fibrillation

“…Not all patients with an early event go on to develop recurrence, however the two are associated to some degree [ 13 ]. More recent studies have shown 90 day recurrence rates of 28% [ 14 ] and one year recurrence rates of 27.6% [ 1 ]. Our data does not reflect outpatient, emergency department, or heart monitor detection of recurrence.…”

A Simple Logistic Regression Model for Predicting the Likelihood of Recurrence of Atrial Fibrillation Within 1 Year After Initial Radio-Frequency Catheter Ablation Therapy

“…At present, the most popular academic view is the pulmonary vein potential theory, so the aim of ablation is to isolate the pulmonary vein potential. However, the treatment effect is not ideal, and the 1-year recurrence rate can reach 30-50% (3,4). Furthermore, to minimize the postoperative recurrence rate and improve the quality of life of patients with Af, this study gathers unique insights by using preoperative biological index information.…”

“…Catheter ablation (CA) is more effective than drug therapy in treating atrial fibrillation (2). However, 30-50% of patients undergoing CA suffer from a recurrence within 1 year of the procedure (3).…”