Arrhythmias and conduction disturbance
Frequency of Recurrence of Atrial Fibrillation Within 48 Hours After Ablation and Its Impact on Long-Term Outcome

https://doi.org/10.1016/j.amjcard.2007.11.021Get rights and content

Because of delayed structural and electrophysiologic effects of radiofrequency ablation of atrial fibrillation (AF), early recurrence of AF after ablation does not necessarily indicate long-term ablation failure. This study was intended to assess the prognostic value of early recurrence of AF within 48 hours after ablation. The study included 234 patients (aged 23 to 80 years; 72% men) with symptomatic drug-resistant paroxysmal (n = 165) or persistent AF (n = 69) who underwent either Lasso-guided segmental pulmonary vein isolation (n = 83) or CARTO-guided left atrial circumferential ablation (n = 151). After a median follow-up of 12.7 months, 64% of patients with paroxysmal and 45% of patients with persistent AF were AF free. Early recurrence of AF occurred in 43% of patients and was more frequently observed in the persistent-AF group (paroxysmal vs persistent 39% vs 54%; p = 0.037). Early recurrence of AF was a significant predictor of long-term ablation failure in univariate (hazard ratio [HR] 2.29, p <0.001) and multivariate (HR 2.17. p <0.001) Cox regression analysis. Nevertheless, 46% of patients with early recurrence of AF were AF free during long-term follow-up compared with 68% of patients without early recurrence of AF. The prognostic value of early recurrence of AF was found in patients with paroxysmal (HR 2.05, p = 0.005) and persistent AF (HR 2.35, p = 0.013). In conclusion, early recurrence of AF within 48 hours after ablation was a significant predictor of a poor long-term ablation outcome. However, because nearly half the patients with early recurrence of AF remained AF free during long-term follow-up, early recurrence of AF should not automatically result in an early repeated procedure.

Section snippets

Patients

The present study was performed in 234 patients undergoing catheter ablation of either symptomatic drug-resistant paroxysmal or persistent AF. Type of AF was defined according to generally accepted guidelines.1 Baseline characteristics of the study population are listed in Table 1. Patients with paroxysmal AF were stratified into 4 groups according to the frequency of AF episodes per month (Table 1).

Preablation treatment

Adequate oral or subcutaneous anticoagulation therapy was given for ≥1 month before the

Results

A total of 234 patients with either paroxysmal (n = 165) or persistent (n = 69) AF were included in the study and underwent either a Lasso catheter-guided or CARTO-guided ablation procedure (Table 1). Compared with the CARTO-guided procedure, the Lasso approach had significantly shorter radiofrequency energy application time (22 ± 11 vs 32 ± 10 minutes; p <0.001), significantly longer fluoroscopic duration (64 ± 18 vs 46 ± 18 minutes; p <0.001), and significantly longer procedure duration (173

Discussion

In the present study, recurrence of AF within the first 48 hours after AF ablation could be identified as a significant predictor of adverse long-term ablation outcome in both univariate and multivariate analyses. This was true not only for the entire study population, but also for subgroups of patients with paroxysmal and persistent AF and patients undergoing a Lasso- or CARTO-guided ablation approach. If AF occurred within the first 2 days after ablation, the independent risk of long-term

Acknowledgment

The authors thank Christina Zeilinger for great support.

References (25)

  • C.R. Vasamreddy et al.

    Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter

    J Cardiovasc Electrophysiol

    (2004)
  • J.Z. Dong et al.

    Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation

    Chin Med J (Engl)

    (2005)
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