Predictors for late recurrences of atrial fibrillation after catheter ablation in patients with early recurrences

Abstract

Purpose: Catheter ablation for atrial fibrillation (AF) is an effective treatment modality for prevention of AF recurrence and improvement of symptoms. Patients with early recurrences (ERAF) directly after catheter ablation are at higher risk to develop late recurrences (LRAF), although many patients with ERAF remain free from AF during follow-up. Consequently, this study determined clinical predictors for LRAF in patients with ERAF. Methods: Rhythm outcome was assessed using in-hospital and serial 7-day Holter ECG monitoring in 2069 patients undergoing radiofrequency AF catheter ablation. Early recurrence of AF (ERAF) was defined as any atrial arrhythmia > 30 seconds occurring within the first week, whereas late recurrence (LRAF) was defined as any episode of AF between 3 and 12 months after ablation. Results: The study population comprised 710 patients with ERAF (62% male, 62±10 years, 57% paroxysmal AF) who underwent RF catheter ablation at the Heart Center Leipzig. Of those, 184 patients (26%) suffered LRAF. On univariate logistic regression analysis, body mass index, GFR, LA diameter, LAA flow velocity and persistent AF were significantly associated with LRAF. On multivariate analysis after adjusting for age and gender, persistent AF (OR 1.7, 95% CI 1.1 – 2.7, p<0.05) remained as only significant predictor for LRAF. Conclusion: Late recurrence in patients with ERAF after catheter ablation occurs in more than one quarter of patients while the majority remains free of AF. Persistent AF has a predictive value for post-ablation LRAF in this population.