Introduction
Methods
Study population
Catheter ablation procedure
Follow-up
Statistical analysis
Results
Baseline characteristics and factors associated with ERAT
Univariate analysis for ERAT | ||||||
---|---|---|---|---|---|---|
No ERAT n = 64 | ERAT n = 143 | Total n = 207 | Odds ratio | 95% Confidence interval | P value | |
Clinical data | ||||||
Age, years | 64.4 ± 11 | 67.3 ± 10 | 66.4 ± 10.7 | 1.025 | 0.998–1.054 | 0.073 |
Male, n (%) | 50 (78.0%) | 87 (60.8%) | 137 (66.2%) | 0.435 | 0.220–0.860 | 0.017 |
BMI, kg/m2 | 28.3 ± 4 | 28.5 ± 5 | 28.4 ± 4.5 | 1.008 | 0.944–1.076 | 0.815 |
Hypertension, n (%) | 42 (65.6%) | 104 (72.7%) | 146 (70.5%) | 1.397 | 0.741–2.632 | 0.301 |
Diabetes mellitus, n (%) | 7 (10.9%) | 23 (16.1%) | 30 (14.5%) | 1.561 | 0.633–3.850 | 0.334 |
Coronary artery disease, n (%) | 22 (34.3%) | 47 (32.8%) | 69 (33.5%) | 0.944 | 0.507–1.761 | 0.857 |
Previous stroke or TIA, n (%) | 1 (1.6%) | 9 (6.3%) | 10 (4.8%) | 4.231 | 0.525–34.127 | 0.176 |
Implanted device, n (%) | 3 (4.7%) | 17 (11.9%) | 20 (9.7%) | 2.743 | 0.774–9.719 | 0.118 |
ß blockers, n (%) | 47 (73.4%) | 112 (78.3%) | 159 (76.8%) | 1.307 | 0.660–2.586 | 0.442 |
ACEi/ARB, n (%) | 40 (62.5%) | 79 (55.2%) | 119 (54.1%) | 0.741 | 0.405–1.355 | 0.330 |
CHA2DS2VASc Score | 2.1 ± 1.5 | 2.7 ± 1.5 | 2.5 ± 1.5 | 1.289 | 1.050–1.583 | 0.015 |
AF history, months* | 13 (5.3;32.5) | 18 (6;48) | 17 (6;47) | 1.002 | 0.995–1.009 | 0.527 |
AF duration, months* | 5 (3;11.5) | 7 (4;13) | 6 (4;12) | 1.015 | 0.993–1.037 | 0.186 |
LV-EF, % | 56.2 ± 8 | 55.2 ± 7 | 55.5 ± 7.6 | 0.981 | 0.940–1.023 | 0.374 |
LA area, cm2 | 27.3 ± 6 | 29.3 ± 6 | 28.7 ± 6.1 | 1.059 | 1.005–1.116 | 0.032 |
Mitral valve insufficiency, moderate or severe, n (%) | 6 (9.3%) | 20 (14%) | 26 (12.6%) | 1.572 | 0.599–4.123 | 0.358 |
Creatinine, mg/dl | 1.0 ± 0.2 | 1.0 ± 0.2 | 1.0 ± 0.2 | 0.636 | 0.171–2.371 | 0.500 |
Glomerular filtration rate, ml/min | 76.8 ± 17.2 | 75.4 ± 18.2 | 75.8 ± 17.9 | 0.996 | 0.979–1.012 | 0.607 |
Procedural data | ||||||
Procedure time, min | 182.2 ± 48.3 | 180.6 ± 44.1 | 181.1 ± 45.3 | 0.999 | 0.993–1.006 | 0.809 |
Radiofrequency time, min | 66.0 ± 18.4 | 66.1 ± 18.8 | 66.1 ± 18.6 | 1.000 | 0.985–1.016 | 0.969 |
Pulmonary vein isolation, n (%) | 64 (100%) | 143 (100%) | 207 (100%) | – | – | > 0.999 |
Substrate ablation, n (%) | 62 (96.9%) | 138 (96.5%) | 200 (96.6%) | 0.890 | 0.168–4.715 | 0.891 |
Linear lesions, n (%) | 10 (15.6%) | 16 (11.2%) | 26 (12.6%) | 0.680 | 0.290–1.595 | 0.375 |
CL difference between baseline and after substrate ablation, ms | 37.4 ± 20 | 34.1 ± 29 | 35.1 ± 26.6 | 0.995 | 0.984–1.008 | 0.458 |
Termination to AT or SR, n (%) | 16 (25%) | 26 (18.1%) | 42 (20.3%) | 0.667 | 0.329–1.353 | 0.261 |
Termination to AT, n (%) | 10 (15.6%) | 18 (12.6%) | 28 (13.5%) | 0.778 | 0.337–1.795 | 0.556 |
Termination to SR, n (%) | 12 (18.7%) | 18 (12.6%) | 30 (14.5%) | 0.624 | 0.281–1.387 | 0.247 |
Follow-up data | ||||||
Late recurrence, n (%) | 28 (43.8%) | 132 (92.3%) | 160 (77.3%) | – | – | < 0.001 |
Time to late recurrence, days | 420.1 ± 333.7 | 155.5 ± 231.5 | 201.8 ± 270.6 | – | – | < 0.001 |
Follow-up, months* | 21.4 (12;41) | 22.2 (9.3;42.3) | 22.2 (10.7;41) | – | – | 0.567 |
Multivariate analysis for ERAT | |||
---|---|---|---|
Predictor | Odds ratio | 95% Confidence interval | P value |
Age | 0.994 | 0.955–1.035 | 0.783 |
Male | 0.539 | 0.255–1.140 | 0.106 |
CHA2DS2VASc Score | 1.231 | 0.896–1.690 | 0.199 |
LA area | 1.057 | 1.002–1.115 | 0.043 |
Predictors of late recurrence (LR) after single ablation procedure
Univariate analysis for late recurrence | |||||
---|---|---|---|---|---|
No late recurrence n = 47 | Late recurrence n = 160 | Odds ratio | 95% Confidence interval | P value | |
Clinical data | |||||
Age, years | 60.8 ± 12.0 | 68.1 ± 9.7 | 1.064 | 1.031–1.099 | < 0.001 |
Male, n (%) | 38 (80.8%) | 99 (61.8%) | 0.384 | 0.174–0.850 | 0.018 |
BMI, kg/m2 | 27.8 ± 3.4 | 28.6 ± 4.8 | 1.042 | 0.967–1.123 | 0.281 |
Hypertension, n (%) | 28 (59.6%) | 118 (73.7%) | 1.906 | 0.965–3.766 | 0.063 |
Diabetes mellitus, n (%) | 3 (6.4%) | 27 (16.9%) | 2.977 | 0.861–10.295 | 0.085 |
Coronary artery disease, n (%) | 14 (29.8%) | 55 (34.4%) | 1.197 | 0.590–2.430 | 0.618 |
Previous stroke or TIA, n (%) | 1 (2.1%) | 9 (5.6%) | 2.742 | 0.338–22.215 | 0.345 |
Implanted device, n (%) | 1 (2.1%) | 19 (11.9%) | 6.199 | 0.807–47.587 | 0.079 |
ß blockers, n (%) | 37 (78.7%) | 122 (76.3%) | 0.868 | 0.395–1.908 | 0.724 |
ACEi/ARB, n (%) | 25 (53.2%) | 94 (58.8%) | 1.253 | 0.652–2.410 | 0.498 |
CHA2DS2VASc Score | 1.8 ± 1.5 | 2.7 ± 1.4 | 1.584 | 1.242–2.020 | < 0.001 |
AF history, months* | 10 (4;25) | 19 (7;49.5) | 1.011 | 1.000–1.022 | 0.040 |
AF duration, months* | 4 (3;10) | 7 (4; 13) | 1.063 | 1.009–1.120 | 0.022 |
LV-EF, % | 56.9 ± 8.1 | 55.1 ± 7.4 | 0.961 | 0.911–1.015 | 0.153 |
LA area, cm2 | 26.7 ± 5.8 | 29.3 ± 6.1 | 1.077 | 1.015–1.142 | 0.014 |
Mitral valve insufficiency, moderate or severe, n (%) | 1 (2.1%) | 25 (15.6%) | 8.519 | 1.123–64.640 | 0.038 |
Creatinine, mg/dl | 1.0 ± 0.2 | 1.0 ± 0.2 | 1.285 | 0.285–5.789 | 0.744 |
Glomerular filtration rate, ml/min | 80.3 ± 16.8 | 74.5 ± 18.0 | 0.982 | 0.964–1.000 | 0.053 |
ERAT | 11 (23.4%) | 132 (82.5%) | 15.429 | 7.010–33.955 | < 0.001 |
Procedural data | |||||
Procedure time, min | 178.3 ± 46.5 | 181.9 ± 45.1 | 1.002 | 0.994–1.009 | 0.632 |
Radiofrequency time, min | 64.5 ± 20.3 | 66.5 ± 18.1 | 1.006 | 0.988–1.024 | 0.506 |
Pulmonary vein isolation, n (%) | 47 (100%) | 160 (100%) | – | – | > 0.999 |
Substrate ablation, n (%) | 46 (97.9%) | 154 (96.3%) | 0.558 | 0.065–4.754 | 0.594 |
Linear lesions, n (%) | 9 (19.1%) | 17 (10.6%) | 0.502 | 0.207–1.214 | 0.126 |
CL difference between baseline and after substrate ablation, ms | 33.4 ± 22.3 | 35.5 ± 27.6 | 1.003 | 0.988–1.019 | 0.681 |
Termination to AT or SR, n (%) | 16 (34%) | 26 (16.2%) | 0.376 | 0.180–0.784 | 0.009 |
Termination to AT, n (%) | 8 (17%) | 20 (12.5%) | 0.696 | 0.285–1.702 | 0.427 |
Termination to SR, n (%) | 15 (31.9%) | 15 (9.3%) | 0.221 | 0.098–0.497 | < 0.001 |
Multivariate analysis for late recurrence | |||
---|---|---|---|
Predictor | Odds ratio | 95% Confidence interval | P value |
Age | 1.042 | 0.976–1.113 | 0.220 |
Male | 0.794 | 0.234–2.694 | 0.711 |
ERAT | 16.828 | 6.184–45.797 | < 0.001 |
LA area | 1.020 | 0.936–1.112 | 0.647 |
AF history | 1.006 | 0.995–1.018 | 0.286 |
AF duration | 1.028 | 0.977–1.083 | 0.285 |
Mitral valve insufficiency, moderate or severe | 6.390 | 0.659–61.996 | 0.110 |
Hypertension | 1.086 | 0.284–4.148 | 0.904 |
Diabetes mellitus | 3.183 | 0.576–17.574 | 0.184 |
Implanted device | 6.310 | 0.386–103.253 | 0.184 |
CHA2DS2VASc Score | 1.119 | 0.612–2.046 | 0.715 |
Glomerular filtration rate | 1.007 | 0.975–1.040 | 0.672 |
Termination to SR | 0.052 | 0.003–0.851 | 0.038 |
Termination to AT or SR | 5.313 | 0.418–67.540 | 0.198 |
Association of ERAT with long-term outcomes
ERAT Timing | LR, % | Hazard ratio* | 95% Confidence interval* | P value |
---|---|---|---|---|
No ERAT (n = 64) | 43.8 | N/A | N/A | N/A |
ERAT during first week (n = 83) | 95.2 | 6.9 | 4.39–10.87 | < 0.001 |
ERAT during second week (n = 16) | 87.5 | 3.6 | 1.91–6.95 | < 0.001 |
ERAT during third week (n = 12) | 83.3 | 3.6 | 1.73–7.40 | 0.001 |
ERAT during fourth week (n = 7) | 100.0 | 5.6 | 2.41–12.82 | < 0.001 |