Impact of Immediate Recurrence of Atrial Fibrillation after Ablation on Long-Term Outcome

Abstract

Background: It had been reported that atrial fibrillation (AF) recurrence immediately after ablation of AF may be caused by acute inflammatory changes after ablation and does not always means long-term AF recurrence. However, the pre-procedural clinical background of that is unclear. Aim: To clarify the clinical background of patients who had AF recurrences within 3-days after ablation (immediate AF recurrence) and the impact of immediate AF recurrences on the long-term outcome. Method: The study included 113 patients (aged 23–78 years; 80% men) with symptomatic drug-resistant paroxysmal (n=89) or persistent AF (n=24) who underwent extensive pulmonary vein ablation. All patients were followed up for more than 3-months (mean 530 days) after the first ablation. Result: Eighteen patients (16%) had immediate AF recurrences (Group-A), 5 (4%) had early recurrences 4–30 days after ablation (Group-B), and the remaining 90 (80%) had no AF recurrences within 1 month after ablation (Group-C). Compared with Group-C, Group-A had more persistent AF patients (p=0.03), higher brain natriuretic peptide levels (p=0.047), larger left atrial volume (p=0.012) and higher E/e′ ratio which is an indicator of left ventricular diastolic dysfunction (p=0.006). The AF free rates after the first AF ablation without anti-arrhythmic drugs in Group-C was superior to that in Group-A and Group-B (P<0.0001 and P=0.02, respectively). Conclusion: The patients who had more left atrial remodeling and left ventricular diastolic dysfunction tend to immediate AF recurrence and poor long-term clinical outcome.