Risk Factors For Atrial Fibrillation Recurrence Research Articles

Abstract 13787: Characteristics and Occupational Trends of Military Tactical Athletes With Repeat Atrial Fibrillation Catheter Ablations

Introduction: Atrial fibrillation (AF) ablation for military personnel aims to provide therapeutic endpoints, recognizing that a subset of personnel require repeat ablation. Objective: This study aims to identify differences in characteristics and occupations of military members who received single versus repeat AF ablation. Further, we aim to understand the rates retention and deployment in those with single versus repeat AF ablation. Hypothesis: We hypothesize that there are increased rates of AF repeat ablations in personnel with risk factors for AF recurrence. Methods: Military personnel who underwent elective AF ablation between 2004 to 2019 were reviewed. Characteristics and military dispositions of personnel with repeated AF ablations were compared to those without. Results: 27 of 104 (26%) personnel received repeat AF catheter ablations on average 16.1±31 months after first ablation. There were no differences between age (34.5+9.5 vs 37.6+9.8 years, P=0.13), BMI (28.1±3.9 vs 28.7±3.4 kg/m2, P=0.48), presence of diastolic dysfunction (11.7% vs 7.4%, P=0.53), left atrial appendage emptying velocities (58.4+22 vs 59.7+23 cm/s, P=0.82), left atrial volume index (29.4+9.9 vs 29.6+8.8 ml/m2, P=0.87), left ventricular ejection fraction (60.4+6% vs 58.5+13%, P=0.31), CHA2DS2-VASc scores (0.37+0.6 vs 0.44+0.7, P=0.60) between those who received a single versus repeated AF ablation. Aviators (40%, 4/10) and healthcare workers (35%, 12/34) underwent repeated ablation at significantly increased rates when compared to 22% of administrators (4/18) and 10% of industrial workers (2/20), (P=0.032). Military retention rates were preserved in those requiring repeated ablation compared to those with single AF ablation (70%, 19/27 vs 78%, 60/77; P=0.60). Deployment rates were statistically similar between those requiring repeated AF ablation compared to single ablation (37%, 10/27 vs 43%, 33/77; P=0.43). Conclusions: Repeat AF catheter ablation rates in military tactical athletes may be driven by specific and individual occupational demands without increased traditional risk factors for AF recurrence. Military retention and deployment rates are preserved for those requiring repeated AF ablation compared to those with single ablation.

Association of acetaldehyde dehydrogenase 2 rs671 polymorphism with the occurrence and progression of atrial fibrillation.

Acetaldehyde dehydrogenase 2 (ALDH2) is an essential enzyme in alcohol metabolism, playing a vital function in resisting oxidative stress. Lots of gene variants have been associated with atrial fibrillation (AF), among which the association between ALDH2 rs671 polymorphism and AF is variable. This study aimed to investigate the relationship between ALDH2 rs671 polymorphism and AF occurrence or progression and AF recurrence after catheter ablation. A total of 924 subjects were enrolled in the study. The ALDH2 genotypes are composed of wild-type homozygotes (ALDH2*1/*1), heterozygotes (ALDH2*1/*2), and mutant homozygotes (ALDH2*2/*2), in which the genotypes ALDH2*1/*2 and ALDH2*2/*2 are combined into the ALDH2*2. Univariate and multivariate logistic regression analyses were performed to investigate the association between ALDH2*2 and AF occurrence and progression. COX regression analysis was used to explore the association of ALDH2*2 with AF recurrence after catheter ablation. The prevalence of AF differed significantly between the ALDH2*2 group (102/251) and ALDH2*1/*1 group (330/673) (P = 0.023). For AF occurrence, in the univariate analysis, alcohol consumption was a risk factors (OR: 1.503, P = 0.003), whereas ALDH2*2 was a protective factor (OR: 0.712, P = 0.023). In the multivariate analysis, alcohol consumption (P = 0.156) and ALDH2*2 (P = 0.096) were no longer independent factors. ALDH2*2 with non-drinking was associated with a decreased AF occurrence (OR: 0.65, P = 0.021), whereas ALDH2*2 with drinking was not (P = 0.365). For AF progression, multivariate analysis revealed ALDH2*2 could promote persistent AF in female AF patients (OR: 2.643, P = 0.008). Cox regression analysis suggested that ALDH2*2 (P = 0.752) was not a risk factor for AF recurrence after catheter ablation during a median 6 months follow-up. While ALDH2*2 was not directly related to AF, ALDH2*2 with non-drinking was associated with a decreased incidence of AF. ALDH2*2 may accelerate AF progression in female patients, increasing the likelihood of developing persistent AF. Therefore, individuals with ALDH2*2 should refrain from consuming alcohol to decrease the onset and progression of AF.

Abstract 13775: Novel Risk Model of Quantitatively Predicting Recurrence of Atrial Fibrillation After the Cox-Maze IV Procedure

Introduction: This study developed a novel risk score model for quantitative prediction of the rate of atrial fibrillation (AF) recurrence after the bipolar radiofrequency Cox-maze IV procedure (CMP-IV) in patients with AF and chronic valvular disease. Methods: We enrolled 408 consecutive patients who underwent the CMP-IV concomitant with valve surgeries in our hospital between 2014 and 2021. We randomly divided the cohort into two groups. A ‘development cohort’for model generation (204 patients; 50%) and a ‘test cohort’for model validation (204 patients; 50%) were calculated by Kaplan-Meier survival curve analysis and receiver operating characteristic curve analysis. Results: The median follow-up was 3.5 (interquartile range: 0.9-6.8) years. The 1-, 3-, 5- and 6-year rates of freedom from AF recurrence in the entire cohort were 91.3%, 87.1%, 80.9% and 76.3%, respectively. Risk factors for AF recurrence examined by multivariate Cox regression analysis included preoperative AF duration >4.4 years, postoperative neutrophil/lymphocyte ratio >9.23, anteroposterior diameter of left atrium >51mm before discharge and AF rhythm at discharge(panel A). Points were assigned to each risk factor according to its hazard ratio. A novel risk score model was developed with a range up to 13 points(panel B). High score (≥7) predicted significantly higher rates of AF recurrence after the CMP-IV than low score (0-3) and medium score(4-6) did in both development cohort(panel C) and test cohort(panel D). The area under the receiver operating characteristic curve of the novel risk model score at 1-, 3- and 5-year was 0.72, 0.80 and 0.89 (95% confidence interval: 0.49-0.95, 0.70-0.90 and 0.81-0.96) respectively in the test cohort(panel E). Conclusions: Surgeons should be cautious to apply the CMP-IV in patients with high model score due to higher risk of AF recurrence.

Successful 4-Year Outcome Following Convergent Ablation for Longstanding Persistent Atrial Fibrillation in an Octogenarian – Novel Therapy for an Old Condition in the Very Elderly

The most common age range for Atrial Fibrillation (AF) prevalence over the coming decades will potentially be in those over 75 years old. However, despite widespread recognition of the strong association between AF burden and age, the elderly are under-represented within trials evaluating invasive rhythm control strategies. We report the outcomes of a gentleman in his late eighties that underwent Convergent hybrid ablation for highly symptomatic and longstanding persistent AF. Now four years later and into his nineties, he remains in sinus rhythm and enjoys good cardiac health without the need for anti-arrhythmic drugs or further intervention. To our knowledge, this case report is the oldest patient to have successfully undergone Convergent ablation with enduring sinus rhythm with long-term follow-up, despite significant risk factors for AF recurrence. As the overall population ages, the emergence of this minimally invasive multidisciplinary ablation technique for AF may offer to similar patients benefits over percutaneous ablation strategies alone.

Higher serum tissue inhibitor of metalloproteinase-1 predicts atrial fibrillation recurrence after radiofrequency catheter ablation.

BackgroundTissue inhibitor of metalloproteinase-1 (TIMP-1) levels is strongly associated with cardiac extracellular matrix accumulation and atrial fibrosis. Whether serum levels of TIMP-1 are associated with atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFCA) remains unknown.Materials and methodsSerum TIMP-1 levels of patients with AF before they underwent initial RFCA were measured using ELISA. Univariate and multivariate-adjusted Cox models were constructed to determine the relationship between TIMP-1 levels and AF recurrence. Multivariate logistic regression analyses were performed to determine predictors of AF recurrence.ResultsOf the 194 enrolled patients, 61 (31.4%) had AF recurrence within the median 30.0 months (interquartile range: 16.5–33.7 months) of follow-up. These patients had significantly higher baseline TIMP-1 levels than those without AF recurrence (129.8 ± 65.7 vs. 112.0 ± 51.0 ng/ml, P = 0.041). The same was true of high-sensitivity C-reactive protein (3.9 ± 6.0 vs. 1.9 ± 2.8 ng/ml, P = 0.001). When a TIMP-1 cutoff of 124.15 ng/ml was set, patients with TIMP-1 ≥ 124.15 ng/ml had a higher risk of recurrent AF than those with TIMP-1 < 124.15 ng/ml (HR, 1.961, 95% CI, 1.182–2. 253, P = 0.009). Multivariate Cox regression analysis revealed that high TIMP-1 was an independent risk factor for AF recurrence. Univariate Cox regression analysis found that substrate modification surgery does not affect AF recurrence (P = 0.553). Subgroup analysis revealed that female sex, age < 65 years, hypertension (HTN), body mass index (BMI) ≥ 24 kg/m2, CHA2DS2-VASc score < 2, HAS-BLED score < 3, and EHRA score = 3 combined with high TIMP-1 level would perform well at predicting AF recurrence after RFCA.ConclusionElevated preoperative TIMP-1 levels are related to a higher risk of AF recurrence and can independently predict AF recurrence following RFCA.

Outcomes of additional substrate modification in de novo atrial fibrillation ablation

Abstract Background Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Data regarding additional substrate modification has been conflicting, both in paroxysmal and persistent atrial fibrillation. Purpose To assess the effect of additional linear substrate modification during de novo AF ablation on AF recurrence. Methods We reviewed 1575 AF ablations in 1254 patients from January 2013 to June 2021 at a single academic medical center. There were 1096 de novo ablations. We defined substrate modification as linear ablations including cavotricuspid isthmus (CTI), superior vena cava isolation, intercaval line, mitral isthmus, and left atrial roof and floor lines. We evaluated clinical and procedural characteristics to identify risk factors for AF recurrence and complications. Patients were followed for a minimum of 6 months. Results The 1096 de novo ablations included 65.5% males with mean age 61.1 years, mean BMI 31.3, 81.8% paroxysmal AF and 18.2% persistent AF. There were four AF ablation subgroups: PVI alone (41.6%), PVI and CTI ablation (37.1%), PVI with CTI and additional substrate modification (15.6%), and PVI with substrate modification without CTI ablation (5.7%). Overall, AF recurred in 36.9% cases. AF recurrence with PVI only ablation was 41% compared to 32.7% in patients with PVI and CTI ablation (p=0.02). When looking at patients with paroxysmal and persistent AF, results were similar, with decreased AF recurrence with the addition of CTI ablation in both paroxysmal (37.3% v. 29.2%, p=0.03) and persistent AF (58.1% v. 40.0%, p=0.02). Additional substrate modification did not result in significant difference in outcome in either paroxysmal or persistent AF (Figure 1). Conclusions In de novo AF ablations, addition of CTI ablation to de novo PVI ablation is associated with lower AF recurrence in both paroxysmal and persistent AF. Additional linear substrate modification did not impact outcomes. Funding Acknowledgement Type of funding sources: None.

Efficacy of cryoballoon ablation for atrial fibrillation in a geriatric population

Abstract Background Cryoballoon pulmonary vein isolation (cryoPVI) is well-established for paroxysmal atrial fibrillation (AF) but its value in persistent AF is less clear. In particular, its efficacy in cardiogeriatric patients (≥75 years) is unknown. Age represents an important modifier of AF progression and is a risk-factor for AF recurrence. Methods We conducted a prospective, single-center study to analyze efficacy and safety of cryoPVI in cardiogeriatric patients stratified according to AF entity. Maximum follow-up was 24 months. Efficacy endpoint was symptomatic AF relapse after 90-day blanking period. Results We included 668 patients. Of these 218 were ≥75 years old. Paroxysmal AF was present in 400 and persistent AF in 268 patients. By means of cox-regression analysis we found age as the only independent factor influencing AF recurrence in the overall cohort (P=0.034). This effect was carried by patients with persistent AF (P=0.006). At 24 months, the recurrence rate was highest in patients with persistent AF and age ≥75 years (57%; P=0.0004). Conclusion Cardiogeriatric patients with persistent AF undergoing cryoPVI had higher rates of AF recurrence compared to elderly patients with paroxysmal AF or younger patients. Against this background we assume, that pulmonary-vein dependent AF may be less frequently encountered among patients ≥75 years with persistent AF. Funding Acknowledgement Type of funding sources: None.

Mitral Annular Plane Systolic Excursion (MAPSE) as a Predictor of Atrial Fibrillation Recurrence in Patients after Pulmonary Vein Isolation.

Introduction Catheter ablation (CA) with pulmonary vein isolation (PVI) has become widely used in the past years for the treatment of atrial fibrillation (AF). Mitral annular plane systolic excursion (MAPSE) is the parameter that measures left ventricular longitudinal function, and it appears to be a good early marker of LV dysfunction. It is practically independent of poor image quality. The aim of our study was to analyse the role of echocardiographic variables, especially MAPSE in predicting the outcome of CA in patients with AF. Materials and Methods We prospectively included 40 patients with paroxysmal and persistent AF that were referred for CA. All patients underwent radiofrequency CA with PVI. Standard transthoracic two-dimensional echocardiography was conducted one day after CA. Demographic data and the patients' characteristics were noted. The endpoint of our study was to estimate the AF recurrence rate diagnosed by ECG within 6 months of the follow-up period. Results 40 patients, mainly male (67.5%) with an average age of 61.43 ± 8.96 years were included in our study. The majority of patients had paroxysmal AF prior to ablation (77.5%). The AF recurrence rate was 20% after 6 months of follow-up. Lateral MAPSE in the AF-free group was greater than those who relapsed (1.57 ± 0.24 vs. 1.31 ± 0.25; p = 0.012). Patients who remained AF-free after a 6-month follow-up period had a significantly smaller left ventricular volume index (LAVI) than those who relapsed (34.29 ± 6.91 ml/m2 vs. 42.90 ± 8.43 ml/m2; p = 0.05). We found a significant reverse relationship between LAVI and MAPSE (p = 0.020). Conclusion MAPSE and LAVI present risk factors for AF recurrence, specifically reduced MAPSE and larger LAVI, are related to AF recurrence after CA. In the future, MAPSE could play a significant role when predicting the CA outcome in patients with AF.

A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation

Introduction and objectivesRecent observations suggest that patients with a previous failed catheter ablation have an increased risk of atrial fibrillation (AF) recurrence after subsequent thoracoscopic AF ablation. We assessed the risk of AF recurrence in patients with a previous failed catheter ablation undergoing thoracoscopic ablation. MethodsWe included patients from 3 medical centers. To correct for potential heterogeneity, we performed propensity matching to compare AF freedom (freedom from any atrial tachyarrhythmia> 30 s during 1-year follow-up). Left atrial appendage tissue was analyzed for collagen distribution. ResultsA total of 705 patients were included, and 183 had a previous failed catheter ablation. These patients had fewer risk factors for AF recurrence than ablation naïve controls: smaller indexed left atrial volume (40.9± 12.5 vs 43.0±12.5 mL/m2, P=.048), less congestive heart failure (1.5% vs 8.9%, P=.001), and less persistent AF (52.2% vs 60.3%, P=.067). However, AF history duration was longer in patients with a previous failed catheter ablation (6.5 [4-10.5] vs 4 [2-8] years; P<.001). In propensity matched analysis, patients with a failed catheter ablation were at a 68% higher AF recurrence risk (OR, 1.68; 95%CI, 1.20-2.15; P=.034). AF freedom was 61.1% in patients with a previous failed catheter ablation vs 72.5% in ablation naïve matched controls. On histology of the left atrial appendage (n=198), patients with a failed catheter ablation had a higher density of collagen fibers. ConclusionsPatients with a prior failed catheter ablation had fewer risk factors for AF recurrence but more frequently had AF recurrence after thoracoscopic AF ablation than ablation naïve patients. This may in part be explained by more progressed, subclinical, atrial fibrosis formation.

High Internal Atrial Defibrillation Threshold Is Related to a High Risk of Recurrence After Catheter Ablation for Long-Standing Persistent Atrial Fibrillation But Not for Persistent Atrial Fibrillation.

The atrial defibrillation threshold (ADFT) for internal cardioversion is theoretically related to the critical mass for sustaining atrial fibrillation (AF). This study aimed to investigate the association of ADFT for internal cardioversion with the outcome of catheter ablation for non-paroxysmal AF (non-PAF). We included 368 consecutive patients who underwent first-time catheter ablation for non-PAF. Based on the degree of ADFT recorded by the internal cardioversion before pulmonary vein isolation, we divided the patients into low ADFT (<20 J) and high ADFT (≥20 J) groups and analysed the association between ADFT and atrial tachyarrhythmia recurrence. There were 234 and 134 patients in the low and high ADFT groups, respectively. Of these, 39 patients (16.7%) and 41 (30.6%) patients, respectively, had atrial tachyarrhythmia recurrence during the 2.6±1.0 year follow-up. The high ADFT group showed a significantly higher atrial tachyarrhythmia recurrence than the low ADFT group (p=0.002). This finding was also noted in patients with long-standing persistent AF (p=0.032) but not in patients with persistent AF (p=0.159). The significant predictors of arrhythmia recurrence on multivariate analysis were high ADFT (p=0.004) and long-standing persistent AF (p=0.011). In multivariate analysis within the long-standing persistent AF group, only ADFT remained a significant risk factor for AF recurrence (p=0.035). The high ADFT of internal cardioversion was found to be a risk factor for post-catheter ablation recurrence in patients with long-standing persistent AF but not in those with persistent AF.

Impact of open-irrigated radiofrequency catheter with contact force measurement on the efficacy and safety of atrial fibrillation ablation: a single-center direct comparison

BackgroundIn atrial fibrillation (AF) patients, catheter ablation of pulmonary veins (PVI) is the most effective therapeutic option to maintain sinus rhythm. To improve successful PVI, contact force–sensing (CF) catheters became routinely available. Previous studies did not clearly show superior clinical efficacy in comparison with non-CF catheters.MethodsWe investigated consecutive patients, who underwent index PVI for AF at our hospital between 2012 and 2018. Three hundred and fifty-four patients were ablated without CF. After availability of CF catheters in 2016, 317 patients were ablated using CF. In case of crossover between the groups, follow-up was censored. The primary endpoint was any documented atrial tachycardia (AT) or atrial fibrillation > 30 s after a 3-month blanking period. Secondary endpoints were procedural characteristics and periprocedural complications.ResultsThere was no significant difference between the groups at baseline except hyperlipidemia. After 365 days of follow-up, 67% of patients in the CF group remained free from AF/AT recurrence compared to 59% in non-CF group (P = 0.038). In multivariable Cox regression analysis, non-CF ablation was an independent risk factor for AF recurrence besides age and persistent AF. Total fluoroscopy time (15 ± 7.6 vs. 28 ± 15.9 min) and total procedure time (114 ± 29.6 vs. 136 ± 38.5 min) were significantly lower for CF-guided PVI (P < 0.001). Complication rates did not differ between groups (P = 0.661).ConclusionsIn our study, the AT/AF recurrence rate and pulmonary vein reconnection rate is lower after CF PVI with a similar complication rate but lower total procedure time and total fluoroscopy time compared to non-CF PVI.

Epicardial adipose tissue is associated with higher recurrence risk after catheter ablation in atrial fibrillation patients: a systematic review and meta-analysis

ObjectiveOur study aimed to investigate the association between epicardial adipose tissue (EAT) and atrial fibrillation (AF) recurrence risk after catheter ablation.MethodsWe searched PubMed, Embase, and Cochrane Library databases up to November 30, 2021 without language restrictions. Outcome was the relative risk (RR) of EAT contributes to AF recurrence after catheter ablation. The RR and 95% confidence interval (CI) was pooled by the random-effect model.Results10 studies that contained 1840 AF patients were included in our study. The result of this study showed that EAT amount was associated with higher risk of AF recurrence after catheter ablation (RR = 1.06, 95% CI 1.02–1.11, P = 0.005) and EAT related thickness was a risk factor for AF recurrence after catheter ablation (RR = 1.73, 95% CI 1.04–2.87, P = 0.040). Sub-analysis showed that EAT was strongly associated with higher risk of AF recurrence common in Asian population (RR = 1.25, 95% CI 1.10–1.43, P < 0.001), patients aged ≤ 60 years old (RR = 2.01, 95% CI 1.18–3.44, P = 0.010), and follow-up more than 1 year (RR = 1.06, 95% CI 1.01–1.11, P = 0.020).ConclusionThe meta-analysis demonstrated that EAT related thickness seems to be the marker most strongly associated with a greater risk of AF recurrences after catheter ablation. It should be included into risk stratification for predicting AF recurrent before catheter ablation.

BMP10 level helps to stratify risk of atrial fibrillation recurrence within one year after catheter ablation

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): DGK Electrophysiology grant Background Freedom of atrial fibrillation (AF) is the main purpose of catheter ablation. However, AF recurrence is commonly seen after catheter ablation. Cardiovascular biomarkers may help to identify patients at risk for AF recurrence. Purpose We investigated the association of preprocedural known and novel cardiovascular biomarker level with AF recurrence within one year after catheter ablation. Methods In 187 patients of the AFAB registry (University Maastricht, the Netherlands) clinical recurrence of AF after catheter ablation was investigated using Holter ECGs at 3- and 12-months follow-up. Blood samples taken before AF catheter ablation were analyzed for prediction of AF recurrence by known or novel cardiovascular biomarkers (FGF23, BMP10, Ang2, IGFBP7, CA125, NT-proBNP, TNT_hs, sFlt_1, ESM1_7F89A5, DKK3). Recurrence of AF was defined as any symptomatic, or ECG documented episode of AF within one year after catheter ablation. A logistic regression model adjusted for typical risk factors of AF recurrence (Sex, age, type of AF (paroxysmal or persistent), ongoing rhythm, LA diameter, heart failure, body mass index and hypertension) was calculated and receiver-operating analysis was performed for prediction of AF recurrence. Results AF recurrence was found in 86 patients within one year after catheter ablation. Elevated biomarker level in patients with AF recurrence were found for BMP10, Ang2, and NT-proBNP in univariate analysis (table 1). In the logistic regression BMP10 (Odds ratio 2.94, 95%CI 1.089-7.939, P=0.033) indicated a high probability of AF recurrence within one year. A model including factors of AF recurrence showed a predictability for AF recurrence of an area under the curve (AUC) of 0.68 (sensitivity 60%, specificity 64%). By adding each of the univariate significant biomarker the predictability of the model increases further Ang2 (AUC 0.69, sensitivity 69%, specificity 60%), NT-proBNP (AUC 0.69, sensitivity 65%, specificity 60%), and BMP10 (AUC 0.71, sensitivity 60%, specificity 73%). Conclusions Based on our data, Ang2, BMP10, NT-proBNP showed elevated values for patients with recurrence of AF within one year before catheter ablation. BMP10, which is likely associated with trabeculation of the heart, outperformed the other investigated known and novel biomarker indicating a higher probability of AF recurrence within one year after ablation.

Long-term comparison of contact force-guided versus conventional irrigated cool-tip circumferential pulmonary vein isolation of atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background In atrial fibrillation (AF) patients, pulmonary vein isolation by means of catheter ablation (CA) is the most effective therapeutic option in order to maintain sinus rhythm. To improve successful PV isolation and effective lesion creation, contact force (CF)-sensing catheters were developed and have become routinely available. Previous studies did not always show superior clinical efficacy in comparison with non-CF CA. Moreover, data about long term clinical outcome are still lacking, especially by patients with persistent atrial fibrillation. Purpose The aim of the present study was to compare the outcome of CF-controlled ablation versus non-CF guided radiofrequency (RF) ablation of AF with regard to ablation characteristics and AF recurrence. Methods Consecutive patients, who underwent a mean 1.7±0.9 point-by-point RF CA for AF at our hospital between January of 2014 and October of 2017, were enrolled in the study. 354 patients were ablated without CF. After routine availability of CF catheters in October of 2016, 165 consecutive patients were ablated using CF. In case of crossover between the groups, follow up was censored. The primary endpoint was any recurrence documented as symptomatic or asymptomatic atrial tachycardia or atrial fibrillation &amp;gt;30 s after the 3-month blanking period. Secondary endpoints were procedural characteristics and periprocedural complications. Results 62% of the enrolled patients had persistent AF. There were no significant differences in baseline characteristics (male gender 63% vs 62%, P=0.846; persistent AF 61% vs. 65%, P=0.496; BMI 29.0±5.2 vs 29.3±5.2 kg/m2, P=0.582; hypertension 76% vs 80%, P=0.369; coronary artery disease 14% vs 20%, P=0.076; left atrial diameter 43.3±7.0 vs 43.8±7.3 mm, P=0.386; diabetes 13% vs 10%, P=0.312; sleep apnoea 7% vs 10%, P=0.167) between the groups, except for older age in the CF group (62.8±10.0 vs 65.0±10.4 years, P=0.021). In the first 12 months arrythmia-free survival was significantly higher in the CF group (Figure 1, Log-Rank (Mantel-Cox) P=0.049). Over 2.8 ± 1.8 years of follow-up, 47% of the patients in the CF group remained free of AF recurrence compared to 36% in the non-CF group (Log-Rank (Mantel-Cox) P=0.236). In multivariable Cox regression analysis using backward elimination, non-CF ablation was an independent risk factor for AF recurrence (HR=1.31; P=0.027) besides age (HR=1.023; P=0.001), persistent AF (HR=1.481; P=0.001), and left atrial diameter (HR=1.023; P=0.004). All other clinical factors were non-significant (Figure 2). Total fluoroscopy time (27.6±16.0 vs. 14.4±7.9 min) and total procedure time (133.4±38.8 vs. 110.1±28.0 min) were significantly lower for CF guided CA (P&amp;lt;0.001). Complication rates did not differ between groups (P=0.123). Conclusions In our long-term single center study the AF recurrence rate was lower after CF PVI as compared to non-CF PVI.

Human Tissue Analysis of Left Atrial Adipose Tissue and Atrial Fibrillation after Cox Maze Procedure.

Cardiac adipose tissue is a well-known risk factor for the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation, but its correlation with maze surgery remains unknown. The aim of this study was to investigate the correlation between the recurrence of AF and the adipose component of the left atrium (LA) in patients who underwent a modified Cox maze (CM) III procedure. We reviewed the pathology data of resected LA tissues from 115 patients, including the adipose tissue from CM-III procedures. The mean follow-up duration was 30.05 ± 23.96 months. The mean adipose tissue component in the AF recurrence group was 16.17% ± 14.32%, while in the non-recurrence group, it was 9.48% ± 10.79% (p = 0.021), and the cut-off value for the adipose component for AF recurrence was 10% (p = 0.010). The rates of freedom from AF recurrence at 1, 3, and 5 years were 84.8%, 68.8%, and 38.6%, respectively, in the high-adipose group (≥10%), and 96.3%, 89.7%, and 80.3%, respectively, in the low-adipose group (<10%; p = 0.002). A high adipose component (≥10%) in the LA is a significant risk factor for AF recurrence after CM-III procedures. Thus, it may be necessary to attempt to reduce the perioperative adipose portion of the cardiac tissue using a statin in a randomized study.

Anxiety is associated with higher recurrence of atrial fibrillation after catheter ablation: A meta-analysis.

Previous studies that evaluated the influence of anxiety on recurrence of atrial fibrillation (AF) after catheter ablation showed inconsistent results. We performed a meta‐analysis of cohort study to systematically evaluate the association between anxiety and AF recurrence after catheter ablation. Electronic databases of PubMed, Embase, and Web of Science were searched for relevant cohort studies from inception to January 20, 2021. We applied the random‐effect model to combine the results to incorporate the potential influence of heterogeneity among studies. Five cohort studies were eligible for the meta‐analysis, which included 549 patients with AF that received catheter ablation. No significant heterogeneity was observed among the included studies (I 2 = 7%, P for Cochrane's Q test = 0.37). During a mean follow‐up of 9.7 months, 216 (39.3%) cases of recurrent AF occurred. Results of the meta‐analysis showed that anxiety was independently associated with an increased risk of AF recurrence after catheter ablation (adjusted relative risk: 2.36, 95% confidence interval: 1.71–3.26; p < .001). Subgroup analyses did not show that differences in study characteristics including study design, ethnicity of the patients, sample size, AF type, anxiety evaluation method, follow‐up duration, or adjustment of LAD may significantly affect the association between anxiety and AF recurrence (p for subgroup difference all > .10). Anxiety may be an independent risk factor for AF recurrence after catheter ablation. Whether alleviating anxiety mood could reduce the risk of AF recurrence after catheter ablation should also be investigated.

Risk factors for late recurrence in patients with nonvalvular atrial fibrillation after radiofrequency catheter ablation.

ObjectiveTo identify the risk factors for postoperative atrial fibrillation (AF) recurrence in nonvalvular AF patients undergoing radiofrequency catheter ablation (CA).MethodsWe retrospectively reviewed the data from 426 of 450 AF patients who underwent CA. Patients were divided into two groups according to recurrence after the operation; the risk factors for AF recurrence were analyzed. A stratification system for lesions was created based on the cutoff of the risk factors; the associations among the subgroups and the AF recurrence rate were analyzed.ResultsAF recurrence occurred in 98 (23.0%) patients. Univariate analysis demonstrated that AF type, hypertrophic cardiomyopathy, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), serum albumin, and D‐dimer concentrations were associated with AF recurrence. AF type (OR =2.907, p < .001), serum albumin concentration (OR =1.112, p < .05), and LAD (OR =1.115, p < .001) were independent risk factors for AF recurrence. The area under the ROC curve of LAD for the prediction of AF recurrence was 0.722 (95% CI: 0.664~0.779) and that of serum albumin for the prediction of AF recurrence was 0.608 (95% CI: 0.545~0.672). Further stratification revealed that patients with persistent or paroxysmal AF with LAD ≥43.5 mm and serum albumin concentration ≥42.2 g/L had a higher rate of AF recurrence than the reference group.ConclusionAtrial fibrillation type, LAD, and serum albumin concentration are risk factors for AF recurrence after CA in patients with nonvalvular AF. Patients with persistent AF with LAD ≥43.5 mm and serum albumin concentration ≥42.2 g/L have a higher risk of late AF recurrence after surgery.

Recurrence of atrial fibrillation after pulmonary vein isolation in dependence of arterial stiffness.

BackgroundArterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Although increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated.MethodsPatients with AF who underwent pulmonary vein isolation (PVI) were included in this study. Presence of AS was evaluated by measuring aortic distensibility (AD) of the descending aorta by transoesophageal echocardiography.ResultsIn total, 151 patients (mean ± standard deviation (SD) age 71.9 ± 9.8 years) were enrolled and followed for a median duration of 21 months (interquartile range 15.0–31.0). During follow-up, AF recurred in 94 (62.3%) patients. AF recurrence was seen more frequently in patients with permanent AF (27% vs 46%, p = 0.03) and in those who had undergone prior PVI (9% vs 23%, p = 0.02). AD was significantly reduced in patients with AF recurrence (mean ± SD 2.6 ± 2.3 vs 1.5 ± 0.7 × 10−3 mm Hg−1, p < 0.0001), as well as left atrial volume index (LAVI) (mean ± SD 29 ± 12 vs 44 ± 15 ml/m2, p < 0.0001). Multivariable analysis revealed LAVI (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2–3.4) and AS (OR 3.6, 95% CI 2.8–4.1) as independent risk factors of AF recurrence.ConclusionIncreased AS and left atrial size were independent predictors of AF recurrence after PVI. AD as surrogate marker of AS seemed to reflect the overall CV risk. In addition, AD was significantly correlated with left atrial size, which suggests that increased AS leads to atrial remodelling and thus to AF recurrence.Trial registrationGerman registry for clinical studies (DRKS), DRKS00019007.Supplementary InformationThe online version of this article (10.1007/s12471-021-01644-w) contains supplementary material, which is available to authorized users.

Abstract 11973: Women Have Less Success of Thoracoscopic AF Ablation Than Men and Suffer More From Established Risk Factors

Background: Women have more recurrent atrial fibrillation (AF) after AF ablation compared with men and are underrepresented in studies. What determines this worse outcome is incompletely understood. Objective: To explore the differential impact of established risk factors for AF recurrence in women and men. Methods: Consecutive patients (n=571) underwent thoracoscopic AF ablation. AF recurrence was defined as any atrial tachyarrhythmia &gt;30s on ECG or Holter, during 2 years of follow-up with exclusion of the first 90 days blanking period. Holters were performed at 3, 6, 9, 12, 15, 18, and 24 months. Predictors of AF recurrence were assessed and compared by sex using the Cox proportional hazards model. Risk ratios (RR) of predictors for AF recurrence were assessed by sex. Results: At thoracoscopic ablation, women were older (63±8 vs. 59±9 years, p&lt;0.001), had higher median [IQR] serum CRP (2.00 [0.90, 4.28] vs. 1.30 [0.65, 2.90] mg/ml p=0.006), but fewer cardiovascular risk factors (myocardial infarction (1.4% vs. 8.6%, p=0.03) and vascular disease (7.0% vs. 16.1%, p=0.01)). There was no difference in the prevalence of hypertension, heart failure, or diabetes mellitus. Freedom of AF recurrence until 2-year follow-up was 42.9% for women vs. 58.3% in men (p=0.002). The added risk for women was highest in patients with persistent AF (RR 1.4, p=0.001) (figure), aged &gt;67y (RR 1.43, p=0.04), and moderate left atrial dilatation (&gt;34 ml/m 2 ) (RR 1.32, p=0.01). Conclusion: Persistent AF, old age, and moderate left atrial enlargement more negatively affect AF freedom in women than in men. Meanwhile, women had similar or fewer cardiovascular risk factors compared to men, underscoring sex as an important contributor to AF recurrence.

Catheter ablation of atrial fibrillation in Korea: results from the Korean Heart Rhythm Society Ablation Registry for Atrial Fibrillation (KARA)

BackgroundThis study aims to investigate the current status of AF (atrial fibrillation) catheter ablation in Korea.MethodsThe patients who underwent AF catheter ablation from September 2017 to December 2019 were prospectively enrolled from 37 arrhythmia centers. Demographic data, procedural characteristics, the extent of catheter ablation, acute success of the ablation lesion set, rate and independent risk factor for recurrence of AF were analyzed.ResultsA total of 2402 AF patients [paroxysmal AF (PAF) 45.7%, persistent AF (PeAF) 43.1% and redo AF 11.2%] were included. Pulmonary vein isolation (PVI) was performed in 2378 patients (99%) and acute success rate was 97.9%. Additional non-PV ablation (NPVA) were performed in 1648 patients (68.6%). Post-procedural complication rate was 2.2%. One-year AF-free survival rate was 78.6% and the PeAF patients showed poorer survival rate than the ones with other types (PeAF 72.4%, PAF 84.2%, redo AF 80.0%). Additional NPVA did not influence the recurrence of AF in the PAF patients (PVI 17.0% vs. NPVA 14.6%, P value 0.302). However, it showed lower AF recurrence rate in the PeAF patients (PVI 34.9% vs. NPVA 24.4%, P value 0.001). Valvular heart disease, left atrial diameter, PeAF, PVI alone, need of NPVA for terminating AF, and failed ablation were independent predictors of AF recurrence.ConclusionsAdditional NPVA was associated better rhythm outcome in the patients with PeAF, not in the ones with PAF. The independent risk factors for AF recurrence in Korean population were similar to previous studies. Further research is needed to discover optimal AF ablation strategy.