Very early recurrence predicts long-term outcome in patients after atrial fibrillation catheter ablation: a prospective study

Abstract

BackgroundLong-term recurrence (LR) is a tendency that re-occurs within 3 months after catheter ablation for atrial fibrillation (AF). Whether very early recurrence (VER) within 7 days of post ablation is a prognostic factor of LR or not is unclear. For this reason, present study sought to examine the relationship between VER and LR.MethodsIn this prospective analysis 378 consecutive patients underwent an initial catheter ablation for paroxysmal or persistent AF. The association between VER and LR was analyzed by univariate and multivariate Cox regression, as well as time-dependent receiver operator characteristic (ROC) analysis.ResultsAfter a mean follow-up of 14.71 ± 8.58 months, 81 (65.90%) patients with VER experienced LR and were associated with lower event of free survival from LR (Log rank test, P < 0.001). Multivariate Cox regression analysis revealed that VER (HR = 7.02, 95% CI = 4.78–10.31; P < 0.001), left atrial enlargement (HR = 2.92, 95% CI = 1.88–4.54; P < 0.001), tendency in advanced age (HR = 1.50, 95% CI = 0.99–2.28; P = 0.054), and tendency in male (HR = 0.71, 95% CI = 0.50–1.01; P = 0.060) were independent predictors of LR. According to time-dependent ROC analysis, it was found that VER was more sensitive than common risk factors in predicting LR (0.74 vs 0.66, P < 0.001) and combination model further improved the C statistic for predicting LR (0.82 vs 0.66, P < 0.001).ConclusionsAfter a single procedure of catheter ablation, patients with VER were strongly associated with LR and combination of VER and common risk factors could further improve prediction of patients who were at high risk for LR.

Early recurrence after pulmonary vein isolation is associated with inferior long‐term outcomes: Insights from a retrospective cohort study

“…However, histopathological studies have shown homogeneous lesion formation as early as 1 week after the CA, 18,19 and recently Xue et al have demonstrated that very ER, occurring within 7 days postablation, have a significant effect on LR. A sensitivity model showed that very ER had a greater prognostic value in predicting LR than common risk factors such as left atrial enlargement, age ≥65 years, and male gender 20 . Another recent study investigating the association between ER and LR using implantable loop recorders showed that not only the occurrence of ER, but also the AF burden significantly affects LR 21 …”

Noninvasive electrocardiography monitoring for very early recurrence predicts long‐term outcome in patients after atrial fibrillation ablation

“…A retrospective study including paroxysmal and persistent AF had found that more than half of patients experienced VER after ablation during 7 days Holter recording (Arya et al., 2010) and a recent prospective study (Xue et al., 2017) shown that nearly one third of patient developed VER after AF ablation. Our study is consisted with these results which demonstrated that VER is common.…”

“…Technical parameters including dynamic range (±5 mV), input impedance (>10 MΩ), common mode rejection (≥60 dB), gain accuracy (≤10%), gain stability (≤3% over a 24‐hr period), system noise (<50uVp‐v), and frequency response (0.67–55 Hz) were set as factory setting. Patients were planned to be monitored for 7 days (Arya et al., 2010; Xue et al., 2017) and returned the device to research assistant after 7 days monitoring. Patients received both verbal and written instructions on how to use the device.…”

“…The suggested atrial arrhythmias episodes were adjudicated by two experienced raters (Jing‐bo Fan and Zhong‐wei Cheng). Very early recurrence was defined as sustained AF or atrial flutter (AFL) or atrial tachycardia (AT) (lasting > 30 s) observed within 7 days postablation (Arya et al., 2010; Xue et al., 2017).…”

“…Most of early recurrences occur within 7 days after ablation (Oral et al., 2002), but studies focusing on the association between very early recurrences (VER) within 7 days postablation and LR are scarce and the clinical significance of VER remains unclear (Arya et al., 2010; Xue et al., 2017).…”