Abstract
The benefits of radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) significantly decrease with late recurrence (LR). We aimed to develop a scoring system to identify patients at high and low risk for LR following RFCA, based on a comprehensive evaluation of multiple risk factors for AF recurrence, including echocardiographic parameters. We studied 2,352 patients with AF undergoing first-time RFCA in a single institution. The LR-free survival rate up to 5 years was measured using a Kaplan-Meier analysis. The influence of clinical and echocardiographic parameters on LR was calculated with a Cox-regression analysis. Duration of AF ≥4 years (hazard ratio [HR] = 1.75; p < 0.001), non-paroxysmal AF (HR = 3.18; p < 0.001), and diabetes (HR = 1.34; p = 0.015) were associated with increased risk of LR. Left atrial (LA) diameter ≥45 mm (HR = 2.42; p < 0.001), E/e′ ≥ 10 (HR = 1.44; p < 0.001), dense SEC (HR = 3.30; p < 0.001), and decreased LA appendage flow velocity (≤40 cm/sec) (HR = 2.35; p < 0.001) were echocardiographic parameters associated with increased risk of LR following RFCA. The LR score based on the aforementioned risk factors could be used to predict LR (area under curve = 0.717) and to stratify the risk of LR (HR = 1.45 per 1 point increase in the score; p < 0.001). In conclusion, LR after RFCA is affected by multiple clinical and echocardiographic parameters. This study suggests that combining these multiple risk factors enables the identification of patients with AF at high or low risk for having arrhythmia recurrence.
Highlights
Atrial fibrillation (AF) is a substantial global health burden, associated with impaired quality of life and increased risk of cardiovascular events[1,2,3,4]
The presence of spontaneous echocontrast (SEC) (70.7% vs. 44.6%, log-rank p < 0.001; hazard ratio (HR) = 2.24, 95% confidence interval (CI) = 1.87–2.68, p < 0.001; Fig. 3a), dense SEC (66.6% vs. 24.2%, log-rank p < 0.001; HR = 3.30, 95% CI = 2.43–4.48, p < 0.001; Fig. 3b), and decreased average LA appendage (LAA) flow velocity (≤40 cm/sec) (72.5% vs. 49.7%, log-rank p < 0.001; HR = 2.35, 95% CI = 1.97–2.79, p < 0.001; Fig. 3c) found during transesophageal echocardiography (TEE) evaluation showed strong associations with late recurrence (LR) for up to 5 years after the last radiofrequency catheter ablation (RFCA)
In accordance with previous studies, we found that longer duration of AF (≥4 years) and history of diabetes mellitus were independently associated with a significantly increased risk of LR following the last RFCA
Summary
Atrial fibrillation (AF) is a substantial global health burden, associated with impaired quality of life and increased risk of cardiovascular events[1,2,3,4]. Recent studies have suggested that RFCA reduces the risk of ischemic stroke in patients with AF12–14. The success rate of RFCA, especially in patients with non-paroxysmal AF, is still not optimal despite recent improvements. The reported success rate of RFCA is between 40–80%, depending on patient characteristics, definition of LR, repeat procedures, and follow-up duration[7,15,19]. Various studies have reported individual risk factors for AF recurrence, but there has been no www.nature.com/scientificreports/. We sought to develop a scoring system to identify the true high- and low-risk groups for LR following their last RFCA procedure, based on a comprehensive evaluation of multiple risk factors for AF recurrence
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