PO-02-219 MODIFIABLE RISK FACTORS PREDICT THE RECURRENCE OF ARRHYTHMIA AFTER PERSISTENT AF ABLATION: ANALYSIS OF THE DECAAF II STUDY

Abstract

The role of risk factors in the development and maintenance of AF is recognized. Isolated risk factors have been implicated in AF recurrence after ablation. However, these have been largely from observational cohorts and in predominantly paroxysmal AF populations. To evaluate the effect of modifiable risk factors on outcomes of catheter ablation in patients with persistent AF. The DECAAF II study randomized 831 patients with persistent AF from 44 centres to pulmonary vein isolation with or without atrial fibrosis ablation. AF recurrence was determined by daily smart phone ECGs, clinical ECGs and ambulatory monitoring. The presence of modifiable risk factors was ascertained at baseline. For this analysis, the population was dichotomized as: Group 1, none or 1 modifiable risk factor; and Group 2, 2 or more modifiable risk factors. Complete risk factor data was available on 823 patients. Compared to Group 1, Group 2 had more modifiable risk factors: greater BMI (P<0.0001); hypertension (P<0.0001); diabetes mellitus (P<0.001); hyperlipidemia (P<0.0001); sleep apnea (P<0.0001); and smoking history (P<0.0001). Additionally, Group 2 were older (P=0.01) and had more vascular disease (P=0.005), coronary artery disease (P<0.0001) and larger left arial volumes (P<0.0001); however, there was no between group difference in atrial fibrosis (P=0.9). Group 2 had greater arrhythmia recurrence (47.8% vs. 37.7%; P=0.005), greater post ablation burden of AF (P=0.006) and shorter time to recurrence (271±195 vs. 310±188 days; P=0.007; Figure). This large multicentre prospective study in patients with persistent AF undergoing catheter ablation demonstrates the effect of modifiable risk factors in determining ablation outcomes. This study highlights the need for risk factor management to improve ablation outcomes in persistent AF.