Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis

Abstract

Context Transcatheter ablation of atrial fibrillation (AF) has undergone important development, with acceptable midterm results in terms of the safety and recurrence. A meta-analysis was performed to identify the periprocedural complications, midterm success rates and predictors of recurrence after AF ablation.Methods and results 4357 patients with paroxysmal AF, 1083 with persistent AF and 1777 with long standing AF were included. The pooled analysis showed that there was an in-hospital complication rate of tamponade requiring drainage of 0.99% (0.44-1.54; CI 99%), stroke with neurological persistent impairment of 0.22% (0.04-0.47; CI 99%), and stroke without of 0.36% (0.03-0.70; CI 99%) After a follow up of 22 (13-28) months and 1.23 (1.19-1.5; CI 99%) procedures per patient, the AF recurrence rate was 31. 20% (24.87-34.81; CI 99%). The persistent AF patients exhibited a greater risk of recurrence after the first ablation (OR 1.78 [1.14, 2.77] CI 99%), but a trend towards non significance was present in the patients with more than one procedure (OR 1.69 [0.95,3.00] CI 99%). The most powerful predictors of an AF ablation failure in the overall population were a recurrence within 30-days (OR 4.30; 2.00-10.80), valvular AF (OR 5.20; 2.22-9.50) and a left atrium diameter of more than 50 mm (OR 5.10 2.00-12.90; all CI 95%).Conclusions Persistent AF remains burdened from higher recurrence rates, however not so following redo-procedures. Three predictors, valvular AF, a left atrium diameter longer than 50 mm and recurrence within 30 days, could be appraised to drive selection of patients and therapeutic strategy. Many observational studies have reported predictors identified by multivariate analyses including the time spent in persistent AF, structural heart disease, left ventricular impairment, and, perhaps most consistently, the left atrial diameter [7]; in the case in which they were confirmed in larger datasets these clinical features could be very useful for cardiologists and general clinicians both for a correct selection of patients deferred to an invasive strategy and to accurately manage the following procedure. However, to the best of our knowledge, no meta-analyses have been performed to appraise the results of real life observational studies of AF ablation, and their complication rates and the most powerful predictors of recurrence. 2.MethodsThe present research was elaborated according to current guidelines, including the recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) amendment to the Search strategy and study selectionMedline, the Cochrane Library and Biomed Central were searched for related articles, according to the established methods [12], with terms related to catheter ablation of AF and predictors of recurrence obtained through multivariate analyses. All corresponding authors of the studies were directly emailed for further data and suggestions for additional research [13]. All citations at the abstract level were first appraised by independent revie...

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

“…High heart failure rate in readmitted subjects in our study compared with Noseworthy et al13 is partly explained by the greater proportion of subjects aged ≥65 years in our study. Readmission rate because of stroke/TIA and bleeding noted in our study is similar to previously published studies 17, 20, 21, 22…”

“…Various studies have reported post‐ablation AF recurrence rate ranging between 13% and 44% with a long‐term follow up 17, 18. Observation by Shah et al5 that 26.9% of readmissions after 30‐day follow‐up in catheter ablated AF patients were attributable to AF and atrial flutter coincide with our study.…”

Left Atrial Function After Radiofrequency Catheter Ablation of Atrial Fibrillation – Can Pre-Ablation Function Predict Contractile Improvement During Follow-up? –

“…Previous studies have suggested that LA enlargement is a powerful predictor of AF ablation failure. 32 The evidence of an LAEF improvement after RFCA, even in patients with moderate-severe LA enlargement, may encourage physicians to consider ablation even in this subgroup of patients.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…328,329,365, 1050,1115,1116,1117 Factors that have been identified as predictors of a poorer outcome, at least in some studies, include (1) non-PAF and particularly long-term persistent AF; (2) sleep apnea and obesity; (3) increased LA size; (4) increased age; (5) hypertension; and (6) LA fibrosis as detected by cardiac MRI. 365 …”