Recurrence of atrial fibrillation after successful radiofrequency catheter ablation of accessory pathway in patients with Wolff-Parkinson-White syndrome

Abstract

Paroxysmal atrial fibrillation (AF) occurs in 11.5-39% of the patients with Wolff-Parkinson-White (WPW) syndrome and frequently, but not always, disappears after successful accessory pathway (AP) ablation. To determine AF recurrence rate, time to AF recurrence and predictors of AF recurrence after radiofrequency (RF) catheter-ablation of AP in WPW-patients with AF. Data from 245 consecutive patients with WPW-syndrome who underwent RF catheter-ablation of AP were analysed. A total of 52 patients (43 men, mean age: 42.5 +/- 14.1 years) with preablation history of spontaneous AF were followed up after definitive AP ablation. At baseline, structural heart disease and comorbidities were diagnosed in 19.2% and 21.2% of the patients, respectively. During the follow-up of 5.2-3.7 years, 3 patients (5.7%) died; one of these patients, previously known for recurrent AF, died from ischaemic stroke. Symptomatic recurrence of AF was detected in 9 of 52 patients (17.3%). In 66.7% of these patients, AF recurrence was identified in the first year following the procedure. Kaplan-Meier analysis demonstrated that freedom from recurrent AF after 3 months was 94.2%, after 1 year 87.5% and after 4 years 84.3%. Univariate analysis showed that older age (p = 0.023), presence of structural heart disease (p = 0.05) and dilated left atrium (p = 0.013) were significantly related to AF recurrence. However, using multivariate Cox regression, older age was the only independent predictor of AF recurrence (HR = 2.44 for every life decade; p = 0.006). Analysis of ROC curves showed that, after the age of 36, the risk of AF recurrence abruptly increased. Symptomatic recurrence of AF was detected in 17% of WPW-patients after definite RF ablation of AP. The time-dependent occurrence of AF recurrences and age-dependent increase in the rate of AF recurrence were identified. Closer follow-up and/or extension of drug therapy in older patients, at least in the first year after the procedure, seem prudent.