After Atrial Fibrillation Recurrence Research Articles

Comparison of early rhythm control strategies in patients with atrial fibrillation: a nationwide population-based cohort study

Abstract Background Early rhythm control within 1-year after atrial fibrillation (AF) diagnosis is associated with a lower risk of major adverse cardiovascular event (MACE). Recently, AF catheter ablation (AFCA) using cryoballoon ablation as initial therapy has been demonstrated to be superior to drug therapy for the prevention of AF recurrence in patients with paroxysmal AF. However, there is still lack of evidence whether AFCA for the method of early rhythm control is superior to medical rhythm control therapy for the reduction of MACE risk. Purpose To evaluate the association between rhythm control treatment and the risk of MACE for early rhythm control in AF patients Methods Using a Korean nationwide claims database, patients with AF who received rhythm control therapy including antiarrhythmic agents (AAD), direct current cardioversion (DCC), and AF catheter ablation (AFCA, radiofrequency ablation or cryoballoon ablation) within 1-year after AF onset between 2011 and 2020 were included. According to rhythm control treatment, patients were categorized two groups as follow: (1) medical rhythm control group who prescribed AAD or underwent DCC, and (2) AFCA group who underwent radiofrequency or cryoballoon ablation. The primary outcome was MACE, the composite of ischemic stroke, admission for heart failure (HF), and myocardial infarction (MI). For the safety outcome, the composite of cardiac tamponade, syncope, sick sinus syndrome, atrioventricular block, pacemaker implantation, and sudden cardiac arrest was evaluated. Multivariable Cox regression analysis were performed. Results A total of 229,056 pateints were included (mean age 67.3±13.6 and 59.4% of men). Mean duration from new AF diagnosis to rhythm control treatment was 29.1±69.2 days. Among total, 221,952 patients received medical rhythm control and 7104 patients received AFCA. Compared to medical rhythm control group, AFCA group was associated with lower risks of ischemic stroke, admission for HF, and MI (adjusted hazard ratio [95% confidence interval]: 0.342 [0.287-0.408], p<0.001 for ischemic stroke, 0.356 [0.282-0.451], p<0.001 for admission for HF, and 0.640 [0.452-0.906], p=0.011 for MI) (Figure A). AFCA for early rhythm control showed a significantly lower risk of MACE than medical early rhythm control (0.328 [0.283-0.380], p<0.001, Figure A). Compared to medical rhythm control, AFCA showed a similar risk for safety outcome (1.197 [0.920-1.556], p=0.180). Among AFCA group, cryoballoon ablation showed comparable risks of ischemic stroke (0.465 [0.113-1.922], p=0.290), admission for HF (0.262 [0.035-1.936], p=0.189), MI (0.823 [0.100-6.767], p=0.856), and MACE (0.449 [0.164-1.228], p=0.118) with radiofrequency ablation (Figure B). Conclusion Regarding on the method of early rhythm control for AF, catheter ablation of AF might reduce the risk of MACE without a significant increase of safety outcome to medical rhythm control. Further results from randomized clinical trials are needed.

Abstract 18852: Machine Learning to Predict Atrial Fibrillation Recurrence Using Pulmonary Vein Morphology

Introduction: Predicting risk of recurrence and sites of recurrence after atrial fibrillation (AF) ablation help direct ablation strategies. While the left atrium (LA) has been implicated as a possible site of AF recurrence leading to ablation directed toward LA substrates, reconnection of pulmonary veins (PVs) has been observed as a mechanism of recurrence on repeat ablations. Hypothesis: Regions of statistical shape differences between AF recurrence (AF+) and non-recurrence patients (AF-) within the PV on a CT scan might be associated with sites of recurrence, that features extracted from these regions may be better predictors of AF recurrence. Methods: A Hierarchical Atlas construction method for PV branching shape analysis was developed. Patients with the median volume of LA plus PV in each cohort were selected as the templates. All CT scans in each cohort were registered to the cohort’s template. Then, each branch was individually registered to the branch’s template and resulting control points applied to the LA and other PV branches to maintain connectivity. This process was repeated with 6 iterations to better adjust branching. Two separate atlases of AF+ and AF- were constructed. The areas of significant shape differences on the PV, surfaces of interest (SOIs), between the two groups were obtained via a General Linear Model based t-test on the atlases. Normal and curvature-based features were extracted from SOI regions. A Gradient Boosting classifier was trained based on these features. Cross-validation and atlas construction involved 104 cases. 50 cases served as a holdout set. Results: The classifier trained on SOI features on CT scans achieved AUCs of 0.76 (cross-validation) and 0.74 (holdout set). SOIs include sites within the left superior PV and the right PV carina. Conclusions: This finding appears to suggest that SOI regions on PVs tend to be associated with recurrence and hence may be candidate sites for additional ablation for preventing recurrence of AF.

Photoplethysmography-documented atrial fibrillation in the first week after catheter ablation is associated with lower success rates.

To test the feasibility of postprocedural photoplethysmography (PPG) rhythm telemonitoring during the first week after atrial fibrillation (AF) ablation and its predictive value for later AF recurrence. PPG rhythm telemonitoring during the first week after the ablation procedure was offered to a total of 382 consecutive patients undergoing AF ablation. Patients were instructed to perform 1 min PPG recordings by a mobile health application 3 times per day and in case of symptoms. Clinicians assessed the PPG tracings via a secured cloud and the information was remotely integrated into the therapeutic pathway via teleconsultation (TeleCheck-AF approach). 119 patients (31%) agreed to perform PPG rhythm telemonitoring after ablation. Patients included in the TeleCheck-AF approach were younger compared to those who declined participation (58 ± 10 vs. 62 ± 10 years, p < 0.001). Median follow up duration was 544 (53-883) days. 27% of patients had PPG tracings suggestive of AF in the week following the ablation. In 24% of patients, the integration of PPG rhythm telemonitoring resulted in a remote clinical intervention during teleconsultation. During follow-up of one year, 33% of patients had ECG-documented AF recurrences. PPG recordings suggestive of AF in the week after ablation were predictive of late recurrences (p < 0.001). PPG rhythm telemonitoring during the first week after AF ablation often triggered clinical interventions. Due to its high availability, PPG-based follow-up actively involving patients after AF ablation may close a diagnostic and prognostic gap in the blanking period and increase active patient-involvement.

PO-02-170 EFFECT OF LOW DOSE COLCHICINE USE ON RECURRENCE OF ATRIAL FIBRILLATION AFTER CATHETER ABLATION

Colchicine is commonly used early after atrial fibrillation (AF) ablation to reduce AF recurrence, but there is limited efficacy data. To evaluate the effect of colchicine use on AF recurrence after ablation. From 2013 to 2021, all AF ablations performed at a single tertiary care medical center were analyzed for colchicine use, clinical and procedural characteristics, and AF recurrence. The colchicine dose was 0.3-0.6mg once daily. The primary outcome was AF recurrence, defined as AF detection for more than 30 seconds after a 3 month blanking period. Propensity score matching (PSM, 1:1 match) was performed using the covariates of gender, age, BMI, AF classification, hypertension (HTN), and diabetes mellitus (DM) based on significant predictors of AF recurrence in prior studies. The minimum duration of follow-up was 6 months. Kaplan-Meier analysis was conducted to assess time to AF recurrence in the entire cohort and the PSM cohort. The study population consisted of 1544 AF ablations in 1231 patients (67% male, age 65 ± 7 years and mean follow up 34 ± 14 months); 78% of the patients received colchicine. Baseline characteristics in colchicine vs no colchicine group showed males (65 vs 69%), mean age (67 vs 63 years), BMI (30 vs 31), paroxysmal AF (70 vs 82%), DM (16 vs 17%), HTN (60 vs 54%), and obstructive sleep apnea (OSA) (18 vs 19%). Colchicine use was associated with decreased AF recurrence (HR 0.78, CI 0.63-0.96, p=0.022; Figure 1A). After PSM, there were 275 patients in each group. Baseline characteristics were not significantly different between both groups. AF recurrence was lower with colchicine (HR 0.71, CI 0.53-0.96, p=0.026; Figure 1B). Colchicine use was associated with decreased AF recurrence in patients with paroxysmal AF (HR 0.70, CI 0.50-0.98, p=0.036) but not persistent AF (HR 0.79, CI 0.39-1.59, p=0.5). Colchicine use was associated with decreased AF recurrence in patients undergoing repeat AF ablation (HR 0.55, CI 0.32-0.96, p=0.036) but not de novo ablation (HR 0.77, CI 0.54-1.1, p=0.2). Colchicine use was associated with lower AF recurrence in patients undergoing AF ablation.

Real-world trends in atrial fibrillation ablation indicate increasing durability of pulmonary vein isolation at repeat ablation.

Durable electrical isolation of pulmonary veins (PVs) is associated with better outcomes after atrial fibrillation (AF) ablation, but previous studies of AF recurrence have reported high rates of reconnection despite successful acute isolation. This study aims to quantify historical trends in the durability of PV isolation (PVI) as radiofrequency (RF) ablation catheters, additional ablation technologies, and associated workflows have evolved. The study population included adult patients receiving a first repeat ablation for AF between September 2013 and July 2019 at the study site. All index ablations were performed at the same site with an RF catheter and included PVI. Three generations of irrigated RF catheters based on the same technology platform were used by the site during the timeframe of this study. A total of 224 patients were included in the analysis. At repeat ablation, the mean number of patients with at least one reconnected PV dropped significantly with subsequent catheter generation, from 78.3% to 56.7% to 27.0% (p<.0001). Moreover, the mean number of reconnected PVs were significantly reduced from 1.48 to 0.92 to 0.47 (p<.0001), representing a 68.3% reduction across the 3 generations of devices. Significant improvement in durable PVI was seen with successive generations of RF catheter over a 6-year period. In addition to catheter technology, ancillary advances in ablation technologies, workflows, and operator experience likely contributed to these improvements.

Predictive value of pre-procedural N-terminal pro-B-type natriuretic peptide level for atrial fibrillation recurrence after radiofrequency catheter ablation.

N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been demonstrated as a valuable risk marker for mortality and morbidity of cardiovascular disease. Recurrence after atrial fibrillation (AF) radiofrequency catheter ablation remains common. We investigated the predictive value of the pre-procedural level of NT-proBNP to differentiate high-risk patients for post-ablation AF recurrence. 326 individuals with nonvalvular AF and preserved systolic function after enduring an initial radiofrequency catheter ablation (RFCA) between March 2018 and December 2019 were categorized into a recurrent group and a non-AF recurrent group. The serum NT-proBNP levels were examined before the ablation procedure. The researchers used multivariate logistic regression to find the determinants of AF recurrence. During a 14-month (interquartile range (IQR): 12-16) median follow-up, AF recurred in 84 (25.8%) patients. Patients in the recurrence group had considerably greater pre-ablation NT-proBNP levels (389.4 vs. 141.7 pg/ml, p < 0.001 in non-paroxysmal AF and 348.0 vs. 99.4 pg/ml, p < 0.001 in paroxysmal AF) as well as a greater left atrium (40 vs. 36 mm, p = 0.01 in non-paroxysmal AF and 38 vs. 36 mm, p = 0.01 in paroxysmal AF) than the non-AF recurrence group. A cut-off value of NT-proBNP ≥ 168.05 pg/ml identified AF recurrence with a sensitivity of 78.6% and specificity of 53.7% (area under ROC curve 0.68, 95% confidence interval (CI) 0.62-0.74, p < 0.001). Kaplan-Meier examination revealed that the elevated NT-proBNP (≥ 168.05 pg/ml) group presented a considerably shorter period without an occurrence compared to the low-NT-proBNP group (18.4 vs. 22.2 months, log-rank p = 0.001). Multivariate cox regression investigation showed that a level of NT-proBNP ≥ 168.05 pg/ml (hazard ratio (HR): 2.89, 95% CI: 1.71-4.903, p < 0.001) was a reliable predictor of AF recurrence after RFCA. A high pre-ablation NT-proBNP level was associated with AF recurrence, and it was also discovered to be a prognostic factor of recurrence of AF following RFCA.

Abstract 9562: High Sensitivity C Reactive Protein and Recurrence After Catheter Ablation for Atrial Fibrillation: A Meta-Analysis

Introduction: The recurrence after atrial fibrillation (AF) ablation is not uncommon. High sensitivity C reactive protein (hs-CRP) is one of the widely used inflammatory markers. We conducted meta-analysis to find association between hs-CRP levels and AF recurrence after ablation. Hypothesis: Higher level of high sensitivity C reactive protein (hs-CRP) may predict the rate of AF recurrence. Methods: We searched PubMed, Embase and Wiley-Cochrane library from inception to January 1, 2022. Overall and subgroup analyses were performed. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to evaluate the associations between hs-CRP levels and post-ablation AF recurrence. Statistical analysis was performed with Stata 14.0. The primary endpoint of this study is to investigate the association of AF recurrence after catheter ablation and hs-CRP levels. Results: We identified ten studies and total 789 patients were included (299 recurrent vs 490 non-recurrent patients). The mean age was 57.7 years (76.4 % male). There was no different in baseline hs-CRP levels between AF recurrence and non-recurrence groups (WMD = 0.05, 95% CI = -0.04-0.15, p = 0.045). However, higher follow-up CRP levels after ablation was associated with higher AF recurrence (WMD = 0.09, 95% CI = 0.03-0.15, p &lt;0.001)(Figure 1 and 2). Conclusions: Higher post ablation hs-CRP level was associated with more AF recurrence. Hs-CRP may play a role as predictor of AF recurrence.

Evaluating the value of the timing of recurrence during blanking period after atrial fibrillation ablation

Abstract Introduction In the first weeks after atrial fibrillation (AF) ablation, the arrythmia may recur theoretically due to transient local inflammation and not due to treatment failure. This is defined as the blanking period, with a proposed duration of 3 months. Recently, this time period has been brought into question. The aim of this work was to evaluate the correlation between the timing of blanking recurrence and late AF recurrence. Methods This was a single-centre retrospective study including patients without structural heart disease that underwent first AF ablation and were subsequently enrolled in the post ablation structured program between 2018 and 2021. Patients were excluded if they had &amp;lt;6 months follow-up. Appointment with ECG and Holter monitoring was performed at 1, 3, 6 and 12 months after ablation. Results We included a total of 193 patients (56% male, mean age 63±12 years). Of these, 79% had paroxysmal AF and mean left atrial volume index was 58±18 mL/m2. During the 3-month blanking period, there were 39 (21%) recurrences, 18 (9%) of which in the first month. After blanking period, at 6 months, 25 (13%) patients had AF recurrence, 56% of which had already recurred during blanking period. AF recurrence in the 2nd and 3rd month of blanking increased the odd of recurrence at 6-month by more than 5-fold (odds ratio (OR) 8,944; CI 95% 2,817–28,400, p&amp;lt;0.001 and OR 5,591; 95% CI 1,173–26,651; p=0.031). On the other hand, recurrence of AF during the 1st month of blanking was not associated with increased chance of 6-month AF recurrence (OR 2,095, 95% CI 0,630–6,964, p=0.227) (figure 1). There were no significant differences in clinical variables, including LA volume, between patients with 1-month recurrence and patients without recurrences. However, patients with AF recurrence in the 2nd and 3rd month of blanking had significantly increased LA volume. Conclusion Our study suggests that patients with AF recurrence in the 2nd and 3rd month of blanking have structurally different atria and are at a significantly higher risk of post blanking AF recurrence, in contrast with patients with AF recurrence in the 1st month of blanking, thus questioning the appropriate duration of the blanking period. Funding Acknowledgement Type of funding sources: None.

Alcohol Consumption Is Associated With Postablation Recurrence but Not Changes in Atrial Substrate in Patients With Atrial Fibrillation: Insight from a High-Density Mapping Study.

BackgroundThe association between alcohol consumption, atrial substrate, and outcomes after atrial fibrillation (AF) ablation remains controversial. This study evaluated the impacts of drinking on left atrial substrate and AF recurrence after ablation.Methods and ResultsWe prospectively enrolled 110 patients with AF without structural heart disease (64±12 years) from 2 institutions. High‐density left atrial electroanatomic mapping was performed using a high‐density grid multipolar catheter. We investigated the impact of alcohol consumption on left atrial voltage, left atrial conduction velocity, and AF ablation outcome. Patients were classified as abstainers (<1 drink/wk), mild drinkers (1–7 drinks/wk), or moderate‐heavy drinkers (>7 drinks/wk). High‐density mapping (mean 2287±600 points/patient) was performed on 49 abstainers, 27 mild drinkers, and 34 moderate‐heavy drinkers. Low‐voltage zone and slow‐conduction zone were identified in 39 (35%) and 54 (49%) patients, respectively. There was no significant difference in the proportions of low‐voltage zone and slow‐conduction zone among the 3 groups. The success rate after a single ablation was significantly lower in drinkers than in abstainers (79.3% versus 95.9% at 12 months; mean follow‐up, 18±8 months; P=0.013). The success rate after a single or multiple ablations was not significantly different among abstainers and drinkers. In multivariate analysis, alcohol consumption (P=0.02) and the presence of a low‐voltage zone (P=0.032) and slow‐conduction zone (P=0.02) were associated with AF recurrence after a single ablation, while low‐voltage zone (P=0.023) and slow‐conduction zone (P=0.024) were associated with AF recurrence after a single or multiple ablations.ConclusionsAlcohol consumption was associated with AF recurrence after a single ablation but not changes in atrial substrate.

Sex difference in atrial fibrillation recurrence after catheter ablation and antiarrhythmic drugs

ObjectiveThe risk of recurrence after atrial fibrillation (AF) catheter ablation (AFCA) is higher in women than in men. However, it is unknown whether a sex difference exists in antiarrhythmic drug...

Impact Of Smoking On Long Term Atrial Fibrillation Ablation Success

Aim: To investigate the recurrence rates after Atrial Fibrillation (AF) ablation therapy in smokers compared to nonsmokers.&#x0D; Material and Method: Patients who underwent Pulmonary Vein Isolation (PVI) ablation for symptomatic AF unresponsive to medical therapy between January 2016 and June 2018 were included in the study. Demographic data and smoking were obtained from medical records registered in the hospital database. For PVI, RF ablation with 3D mapping or Cryobalon ablation was performed according to operator preference. A 12-lead surface electrocardiogram and 24-hour ambulatory Holter electrocardiogram were performed at 1 and 3 months after the procedure and every 3 months thereafter. A 3-month blind period was used when evaluating AF recurrences. AF recurrence was defined as an episode lasting longer than 30 seconds. New onset atrial tachycardia and atrial flutter were also considered as recurrences.&#x0D; Results:139 patients who underwent AF ablation were included in our study. AF recurrence was observed in 38 (27.3%) of the patients included in the study during a total follow-up period of 37 months. Age, gender, hypertension and diabetes history were similar in both groups (all p values&gt; 0.05). However, smokers were more common in the relapsed group (39.5% vs. 21.8%, p=0.03). Except for 0.3 mg/dl, p=0.04) values, no significant biochemical parameter affecting AF recurrence was detected. As a result of multivariate regression analysis, independent predictors of recurrence after AF ablation were smoking (OR=2.29, 95% CI 1-5.23, p=0.05) and Neutrophil/Lymphocyte Ratio (NLR) over 3 (OR=3.08, 95% CI 1.09). -8.69, p = 0.033).&#x0D; Conclusion: It was determined that recurrence after AF ablation treatment was higher in smokers compared to non-smokers. Smoking cessation therapy should be considered primarily in order to prevent recurrence in patients receiving AF ablation therapy.

Comparison of co-administration of amiodarone and rivaroxaban to co-administration of dronedarone and rivaroxaban for hemorrhage risks after atrial fibrillation ablation

PurposeTo investigate whether co-administration of antiarrhythmic dronedarone and anticoagulant rivaroxaban would increase the risks of hemorrhage after atrial fibrillation (AF) ablation.MethodsA total of 100 patients with AF who underwent radiofrequency catheter ablation (CA) in the Department of Cardiology, the Affiliated Hospital of Qingdao University from 2019–12 to 2020–11 were included. Patients were divided into an oral dronedarone and rivaroxaban group (D-R group, N = 50) and an oral amiodarone and rivaroxaban group (A-R group, N = 50) according to the postoperative antiarrhythmic and anticoagulation strategies. Patients in 2 groups were given propensity score matching (PSM) to obtain a sample with balanced inter-group covariates. A retrospective observational study was conducted. After 3 months of follow-up, the incidence of clinically relevant non-major bleeding (CRNMB), major hemorrhages, and early AF recurrence was observed.ResultsAfter PSM, 41 patients were included in each group. With similarly distributed baseline characteristics and ablation characteristics after PSM, the CRNMB rate after AF ablation was significantly higher in the D-R group than in the A-R group (26.8% versus 7.3%, P = 0.02), and no major hemorrhages were detected in both groups. No significant difference was observed in the sinus rhythm maintenance rate between the D-R group and the A-R group (26.8% vs. 22.0%, P = 0.43).ConclusionsCompared to co-administration of amiodarone and rivaroxaban, co-administration of dronedarone and rivaroxaban increases the risk of CRNMB but it does not increase the risk of major hemorrhages in blanking period after AF ablation.

Aortic plaques in patients with atrial fibrillation: an often-forgotten risk factor for thromboembolism

Abstract Background CHA2DS2-VASc risk score is the main determinant for maintaining anticoagulation after atrial fibrillation (AF) ablation, irrespective of the procedure outcome. The presence of aortic plaques is included in the score, but isn't regularly assessed previously to AF ablation. This way, risk factors for coronary artery disease (CAD) other than arterial hypertension and diabetes mellitus may influence stroke risk in patients with AF, albeit not being included in the CHA2DS2-VASc score. Purpose We sought to evaluate the prevalence of aortic plaques diagnosed during transesophageal echocardiography (TOE) in patients submitted to AF ablation and to assess its determinants and clinical impact on the CHA2DS2-VASc score. Methods Retrospective study of patients submitted to AF ablation that performed TOE prior to the procedure, with assessment of aortic plaques. CHA2DS2-VASc risk score was evaluated in the pre-ablation patient evaluation and reassessed after TOE. Demographic, clinical and echocardiographic data, including cardiovascular risk factors, were analyzed. We assessed AF recurrence rate, cerebrovascular events and death during follow-up. Results 120 patients were submitted to TOE prior to AF ablation from November 2015 to December 2020, mean age 66.6 (±9.55) years, 48% male. In 30 (25%) patients aortic plaques were identified in TOE. Mean CHA2DS2-VASc was 2.2 (±1.47) in pre-ablation evaluation and 2.5 (±1.69) post-TOE, increasing in all patients with aortic plaques and prompting beginning of oral anticoagulation in 5 patients. AF was paroxysmal in 74% and persistent in 26% of patients, mean duration of 6.28 (±3.76) years. Arterial hypertension was present in 79 (66%) of patients, type 2 diabetes mellitus in 24 (20%) and dyslipidemia in 67 (56%). 17 (14%) patients had a prior stroke. During a mean follow-up of 30 (±18.3) months, 32 (27%) patients had AF recurrence and 10 (8%) were submitted to redo procedures. 107 (89%) patients remained under oral anticoagulation, stroke occurred in 1 patient and 2 patients died. In univariate analysis, age, type 2 diabetes mellitus and dyslipidemia predicted an increase in CHA2DS2-VASc score after TOE (respectively, OR 1.113, 95% CI 1.041–1.190, p-value 0.002; OR 2.907, 95% CI 1.145–7.379, p-value 0.025; and OR 2.442, 95% CI 1.016–5.868, p-value 0.046). In multivariate analysis, age is the only independent predictor of increased CHA2DS2-VASc score after TOE (OR 1.095, 95% CI 1.013–1.185, p-value 0.023). No risk factor for CAD was independently associated with the presence of aortic plaques (Table 1). Conclusion In this population, single CAD risk factors were not independent predictors of aortic plaques. If TOE had not been performed prior to AF ablation, 25% of patients would have had an underestimated CHA2DS2-VASc score and would be off anticoagulation after the procedure, unprotected from thromboembolic events. Funding Acknowledgement Type of funding sources: None. Table 1

Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation has no impact on recurrences, cardiovascular events and mortality – insights from the German Ablation Registry

Abstract Background Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after atrial fibrillation (AF) catheter ablation are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients' treatment burden. Methods Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after AF catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcome. Results In patients with paroxysmal AF (n=2138) recurrence and rehospitalization rates did not differ when discharged with (n=1051) or without (n=1087) AAD (recurrence: adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95–1.35]; rehospitalization: OR 1.08, 95% CI [0.90–1.30]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05–1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20–2.58]). Similar rates of recurrences, rehospitalisations, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95–1.56]; rehospitalization: OR 1.16, 95% CI [0.90–1.50]; reablation: OR 1.21, 95% CI [0.91–1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74–2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in paroxysmal and persistent AF patients discharged with or without AAD. Conclusion The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction. Funding Acknowledgement Type of funding sources: None.

Persistence of left atrial abnormalities despite left atrial volume normalization after successful ablation of atrial fibrillation.

BackgroundLeft atrial volume index (LAVI) of >34 mL/m2 is the cutoff value for identifying an enlarged left atrium. The definition of left atrial (LA) reverse remodeling after atrial fibrillation (AF) ablation is undetermined. We hypothesized that patients with LA dilatation who achieve normal LA volume (LAVI<34 mL/m2) after AF ablation have better long‐term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume can also achieve normal LA function with AF ablation.MethodsWe enrolled 140 AF patients with baseline LAVI of ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle‐tracking echocardiographic parameters within 24 hour and at 1 year after the procedure. To define the normal range of LA function, age‐ and sex‐matched controls without a history of AF were also enrolled.ResultsAfter restoration of sinus rhythm, LA structural and functional parameters significantly improved, and 75 patients (54%) had normal LA volume. During a median follow‐up of 44 (31‐61) months, 32 patients (23%) experienced a late recurrence of AF (AF recurrence >1 year). Patients who achieved normal LA volume after AF ablation had fewer late recurrences than those who did not (P < .01). However, LA abnormalities, especially LA dysfunction, persisted in AF patients even when the LA volume was normalized compared with controls.ConclusionPatients who achieved normal LA volume had better long‐term outcomes of AF ablation than those who did not; however, LA abnormalities persisted even after successful ablation of AF.

Atrial Fibrillation Recurrence Prevention after Electrical Cardioversion in High-Risk Patients – Benefits of Non-Antiarrhythmic Drugs

Background: Recurrence prevention after Atrial Fibrillation (AF) termination by Eelectrical Cardioversion (ECV) remains challenging. Increasing attention is paid to pathophysiological effects of non-Antiarrhythmic Drugs (non-AADs), nevertheless, with heterogeneous results. Objective: We evaluated the potential benefits of different non-AADs as adjunctive therapy to Antiarrhythmic Drugs (AADs) for AF recurrence prevention after sinus rhythm restoration by ECV in high-risk patients. Methods: The study was conducted among high-risk AF patients after successful ECV. Prescription of class IC or class III AAD was required. Data were acquired in a face-to-face baseline interview and 1-, 3-, 6-, 9-, 12-month follow-up interviews. Results: 113 patients were included. Total AF recurrence rate reached 48.7%. Angiotensin-Converting Enzyme Inhibitor (ACEI) or angiotensin receptor blocker (ARB) intake, compared with non-use, demonstrated AF recurrence rate reduction by 8.5% (46.3 vs. 54.8%), with odds ratio (OR) reduced by 28.9% (OR 0.711, 95% confidence interval (CI) 0.310-1.631, p = 0.420). Among mineralocorticoid receptor antagonist (MRA) users, AF recurrence rate was reduced by 25.1% (29.6 vs. 54.7%) and OR by 65.1% (OR 0.349, 95%CI 0.138-0.884, p = 0.023). Present statin therapy reduced AF recurrence rate by 4.2% (46.8 vs. 51.0%) and OR by 15.5% (OR 0.845, 95%CI 0.402-1.774, p = 0.656). Diuretic use showed reduction of AF recurrence rate by 10.2% (41.7 vs. 51.9%) and OR by 33.9% (OR 0.661, 95%CI 0.297-1.469, p = 0.308). Conclusion: Non-AADs demonstrated practical benefits as adjunctive therapy to AADs for AF recurrence prevention after ECV in high-risk patients, with statistically significant results established for concomitant MRA intake.

Electrocardiographic predictors of early recurrence of atrial fibrillation.

BackgroundElectrical cardioversion (ECV) is an effective method for restoring sinus rhythm after atrial fibrillation (AF). However, early recurrence of AF occurs in a significant number of patients after ECV. This study aimed to identify electrocardiographic (ECG) predictors of early AF recurrence after ECV.MethodsA total of 272 patients with persistent AF undergoing successful ECV were consecutively enrolled in this study. We investigated clinical, echocardiographic, and ECG data. The 12‐lead ECG parameters were measured during sinus rhythm right after ECV using a digital caliper. The early AF recurrence was defined as recurrence within 2 months.ResultsOf the 272 patients, 165 patients (60.7%) experienced an early AF recurrence. Maximum P‐wave duration (PWD) in limb leads (OR: 1.086; 95% CI: 1.019–1.157; p = .012) and P‐terminal force (PTF) in V1 (OR: 1.019; 95% CI: 1.004–1.033; p = .011) were independent predictors of early AF recurrence after ECV. The optimal cutoff value of the maximum PWD in limb leads for predicting early AF recurrence was 134 ms, characterized by 90.3% sensitivity and 72.0% specificity. Likewise, the optimal cutoff value of PTF in V1 was 50 ms × mm, characterized by 80.0% sensitivity and 64.5% specificity.ConclusionA longer PWD (>134 ms) and a larger PTF (>50 ms × mm) were useful predictors of early recurrence of AF after successful ECV in clinical practice. A more effective rhythm control therapy such as catheter ablation or rate control strategy rather than a repeat ECV should be considered.

Long-term intermittent versus short continuous heart rhythm monitoring for the detection of atrial fibrillation recurrences after catheter ablation

BackgroundThe utility of long-term intermittent heart rhythm monitoring after atrial fibrillation (AF) ablation remains unclear. Therefore, we compared the efficacy and usability of long-term intermittent (AliveCor Kardia® (ACK)) versus short continuous (Holter) heart rhythm monitoring for the detection of AF recurrences after AF ablation and evaluated ACK accuracy to detect AF. MethodsPatients were provided with Holter (for ≥24 h) simultaneously with an ACK (4 weeks) used three times a day and in case of symptoms. The primary endpoint was the difference in proportion of patients diagnosed with recurrent AF by ACK as compared to Holter monitoring. Secondary endpoints were the usability (System Usability Scale and a four-item questionnaire) of ACK and Holter monitoring; and the accuracy of the ACK algorithm for AF detection. ResultsOut of 126 post-ablation patients, 115 (91.3%; 35 females, median age 64.0 [58.0–68.0] years) transmitted overall 7838 ACK ECG recordings. ACK and Holter monitoring detected 29 (25.2%) and 17 (14.8%) patients with AF recurrences, respectively (p < 0.001). More than 2 weeks of ACK monitoring did not have additional diagnostic yield for detection of AF recurrences. Patients graded ACK higher than Holter monitoring and found ACK more convenient in daily usage than Holter (p < 0.001). Sensitivity and specificity of ACK for AF detection were 95.3% and 97.5%, respectively. ConclusionsLong-term intermittent monitoring by ACK more effectively detects AF recurrences after AF ablation and has a higher patients' usability than short continuous Holter monitoring. ACK showed a high accuracy to detect AF.

Clinical relationship between anemia and atrial fibrillation recurrence after catheter ablation without genetic background

BackgroundAnemia is a known adverse prognostic factor among patients with cardiovascular diseases. We investigated whether the hemoglobin level was associated with the rhythm outcome after atrial fibrillation (AF) catheter ablation (AFCA). MethodsWe included 2627 patients who underwent AFCA and a guidelines-based rhythm follow-up (age 58 ± 10.9 years, 73% men, 30.6% with persistent AF), and evaluated the association of pre-AFCA anemia (haemoglobin <13 g/dL in men and <12 g/dL in women) and rhythm outcomes. We studied the mechanistic relationship between anemia and AF recurrence using a Mendelian randomization analysis (1775 subjects with genome-wide association study) after reviewing already proven 12 hemoglobin-associated genetic polymorphisms. ResultsThe body mass index, paroxysmal AF, warfarin use, and baseline red cell distribution width were independently associated with anemia in patients with AF. During a 23-month follow-up (interval OR 9–48 months), the clinical AF recurrence rate was significantly higher in patients with than without anemia (log-rank p = 0.001; propensity score-matched log-rank p = 0.004). This pattern was more significant in male patients (Log-rank p < 0.001) or patients with paroxysmal AF (Log-rank p < 0.001). Anemia (hazard ratio [HR] 1.45 [1.17–1.80], p = 0.001), left atrial diameter (HR 1.03 [1.01–1.04], p < 0.001), a female sex (HR 1.17 [1.00–1.36], p = 0.047), and persistent AF (HR 1.58 [1.36–1.84], p < 0.001) were independently associated with post-AFCA clinical recurrence. In the Mendelian randomization, we could not find a significant direct causal relationship between anemia and AF recurrence at the genetic level. ConclusionsPre-AFCA anemia is an independent predictor of post-AFCA clinical recurrence, especially in male patients, without a genetically direct causal relationship.

P1026Risk factors for the occurrence of stroke after atrial fibrillation ablation

Abstract Background Risk factors for the occurrence of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated. Our aim was to assess incidence of ES during long-term follow-up following AF ablation and to identify predicting factors associated with post-ablation ES. Methods We enrolled patients who experienced ES after AF ablation and body mass index-matched controls from AF ablation registries. Epicardial adipose tissue (EAT) was assessed using multislice computed tomography prior to ablation. Results A total of 3,464 patients who underwent AF ablation were recruited. During a mean follow-up of 47.2 months, ES occurred in 47 patients (1.36%) with a mean CHA2DS2-VAS score of 2.15 and overall incidence of ES was 0.34 per 100 patients/year. Compared with control group (n=190), ES group had more higher prior thromboembolic event and AF recurrence rates, larger LA size, lower creatinine clearance rate (CCr), and greater total and periatrial EAT volumes although no differences in AF type, CHA2DS2-VASc score, ablation extent, and anti-thrombotics use were found. On multivariate regression analysis, a prior history of thromboembolism, CCr, and periatrial EAT volume were independently associated with ES occurrence after AF ablation. Cox regression analysis Risk factor Univariate Multivariate HR (95% CI) p value HR (95% CI) p value Age 1.017 (0.984–1.051) 0.31 Prior thromboembolism 2.488 (1.134–5.460) 0.023 2.916 (1.178–7.219) 0.021 CHA2DS2-VASc score 1.139 (0.899–1.445) 0.282 CCr 0.984 (0.970–0.999) 0.038 0.982 (0.996–0.998) 0.029 LA diameter (mm) 1.070 (1.012–1.130) 0.017 1.072 (0.999–1.150) 0.054 EAT_total (ml) 1.020 (1.010–1.029) &lt;0.001 1.008 (0.993–1.023) 0.297 EAT_periatrial (ml) 1.085 (1.045–1.126) &lt;0.001 1.065 (1.005–1.128) 0.032 PVI + additional ablation 0.846 (0.460–1.557) 0.592 No anticoagulant use 0.651 (0.346–1.226) 0.184 Recurrence 2.011 (1.007–4.013) 0.048 1.240 (0.551–2.793) 0.603 CCr, creatinine clearance rate; EAT, epicardial adipose tissue; LA, left atrium; PVI, pulmonary vein isolation. K-M curve for stroke-free survival Conclusions Incidence of ES after AF ablation was lower than expected rate based on CHA2DS2-VASc score even though anticoagulants use was limited. Periatrial EAT volume, a prior thromboembolism event, and CCr were independent factors in predicting ES irrespective of AF recurrence and CHA2DS2-VASc score in patients who underwent AF ablation.