Early recurrence is a predictor of recurrence after catheter ablation in the patients with persistent atrial fibrillation

Abstract

Introduction: Radiofrequency catheter ablation has been established as effective therapy for drug-refractory atrial fibrillation (AF). However, a significantly high recurrence rate remains as a problem to be resolved in long-standing persistent AF. It has been accepted that early atrial tachyarrhythmia including recurrence of AF and occurrence of atrial tachycardia (AT) during the first 3 months after catheter ablation, defined as blanking period, may not always lead to late recurrence of AF/AT. The aim of this study was to evaluate the relationship between early recurrence and late recurrence of AF/AT after catheter ablation in patients with long-standing of persistent AF. Methods: This study included 161 patients with long-standing persistent AF (sustained AF duration; 1 to 20 years, with a mean of 3.4±3.8 years) who underwent primary catheter ablation. Recurrence of AF and occurrence of AT within the first 3 months following catheter ablation was defined as early AF/AT recurrence. Results: RFCA was successfully performed in all patients. During the 24-month follow-up period, 86 (53%) patients had AF/AT recurrence and 74 (86%) patients of those had AF recurrence and remaining 12 (14%) patients of those had AT occurrence. During the first 3 months after catheter ablation, 82 (50%) patients had AF/AT recurrence. After transient AAD therapy and/or external cardioversion, 15 (18%) patients converted to and maintained sinus rhythm. In the other 67 (82%) patients, AF/AT continued or recurred during the 24-month follow-up period. By univariate analysis, duration of sustained AF, left atrial diameter, left atrial volume index, and early AF/AT recurrence were significantly associated with late AF/AT recurrence after catheter ablation (p<0.001, p=0.010, p=0.017, p<0.001, respectively). Early AF/AT recurrence was the independent predictor of late AT/AF recurrence after catheter ablation (hazard ratio [HR]=5.97, 95% confidence interval [CI]=3.50-10.16, p<0.001) as well as the sustained AF duration (>3 years, HR=1.93, 95% CI=1.25-2.99, p<0.001) and left atrial diameter (HR=1.03, 95% CI=1.01-1.07, p=0.05) in the cox multivariable analysis. Conclusions: Early AF/AT recurrence was significantly associated with late AF/AT recurrence after catheter ablation in patients with long-standing persistent AF. The prevention of early AF/AT recurrence might be able to reduce the late AF/AT recurrence after catheter ablation of AF.