Mechanisms of long-term recurrence three years after catheter ablation of atrial fibrillation

Abstract

Abstract Background AF is a progressive disease, and the mechanism underlying long-term recurrence after AFCA is unclear. Purpose This study explored the potential mechanisms of long-term recurrence (LTR) of atrial fibrillation (AF) 3-years after AF catheter ablation (AFCA). Methods Among 2,209 consecutive patients who underwent AFCA, 1,325 (59±11 years, 72.5% male) who underwent regular rhythm follow-ups for >3-years were enrolled. Among them, 659 patients remained in sinus rhythm (SR), 327 recurred after 3–12 months (short-term recurrence; STR), 235 after 1–3 years (mid-term recurrence; MTR), and 104 after 3-years (long-term recurrence; LTR). Two hundred eighteen recurrent patients underwent repeat procedures: 112, 80, and 26 in the STR, MTR, and LTR groups, respectively. Results The pre-ablation left atrial (LA) dimensions were larger in the STR (p<0.001) and MTR groups (p<0.001), but not in the LTR group compared to the SR group. Low LA voltages were independently associated with an LTR (adjusted HR 0.57 [0.36–0.92], p=0.022). Upon the redo-mapping, the number of reconnected pulmonary veins (PVs) was 2.0 (IQR 0–3), 1.5 (IQR 0–3), and 1.0 (IQR 0–2) in the STR, MTR, and LTR groups, respectively (p=0.030). Post-ablation extra-PV triggers were more commonly found in the LTR than STR or MTR groups (LTR 40.9% to STR 19.2%, p=0.014) during the second procedure. Conclusions The LTR group had a similar baseline LA size and significantly lower LA voltage than the SR group. In the repeat procedures, the LTR group had fewer reconnected PVs, but extra-PV triggers were more common than in the STR and MTR groups. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Ministry of Health and Welfare, Ministry of Science, ICT & Future Planning (MSIP).