Optimal cutoff duration of history or persistence of atrial fibrillation to undergo radiofrequency catheter ablation of longstanding atrial fibrillation

Abstract

Abstract Background The limitations of catheter ablation for longstanding atrial fibrillation (LsAF) are beginning to emerge and appropriate patient selection are needed. It is well known that the longer the duration of atrial fibrillation (AF), the less likely it is to be cured by catheter ablation. Purpose To identify the optimal cutoff duration of AF to predict outcomes after catheter ablation in patients with LsAF in the contact force sensing catheter (CF) era. Methods From the EARNEST-PVI (Effect of Extensive Ablation on Recurrence in Patients with Persistent AF Treated with Pulmonary Vein Isolation) trial, which was a prospective, multicenter, randomized, open-label trial, comparing the pulmonary vein isolation (PVI) alone and PVI plus additional substrate ablation, factors associated with arrhythmia-free survival after a 3-month blank period were evaluated in patients with LsAF. Results Among 124 patients, CF was used in 114 (92%). Duration of AF history and persistence were related to recurrences. Other factors, including age, gender, left atrial diameter, chronic kidney disease and substrate ablation, were not related to recurrences (Table). Receiver operating characteristic analysis detected suitable cutoff duration of AF history and AD persistence as both 2.4 years (area under curve; 0.654 and 0.609, respectively)). The arrhythmia-free survival was significantly better in patients with AF history ≤ 2.4 years than the others (p=0.001, HR 2.69, 95% CI: 1.47-4.89) and better in patients with AF persistence ≤ 2.4 years than the others (p=0.008, HR 2.04, 95% CI: 1.19-3.48) (Figure). Conclusion Duration of AF history or persistence ≤ 2.4 years were suitable to undergo radiofrequency ablation of LsAF.TableFigure