Year: 2020
Type: article
Abstract: AIMS: Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50-70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. METHODS AND RESULTS: We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA-AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93-2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20-2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26-2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00-1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). CONCLUSION: Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02227550.
Source: EP Europace
Authors: Matthias Daniel Zink, Winnie Chua, Stef Zeemering, Luigi di Biase, Bayes de Luna Antoni, Callans David, Gerhard Hindricks, Karl Georg Haeusler, Hussein R Al-Khalidi, Jonathan P Piccini, Lluís Mont, Jens Cosedis Nielsen, Luis Alberto Escobar, Joseph de Bono, Isabelle C Van Gelder, Tom de Potter, Daniel Scherr, Sakis Themistoclakis, Derick Todd, Paulus Kirchhof, Ulrich Schotten
Institutions: Maastricht University, Universitätsklinikum Aachen, RWTH Aachen University, University of Birmingham, Albert Einstein College of Medicine, Universitat Autònoma de Barcelona, Hospital de Sant Pau, Hospital of the University of Pennsylvania, Leipzig University, Universitätsklinikum Würzburg, Duke Medical Center, Duke Clinical Research Institute, Hospital Clínic de Barcelona, Universitat de Barcelona, Aarhus University Hospital, University Hospitals Birmingham NHS Foundation Trust, University Medical Center Groningen, University of Groningen, Onze Lieve Vrouwziekenhuis Hospital, Medical University of Graz, Ospedale dell' Angelo, Liverpool Heart and Chest Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,909
Awards: G1357640399, Understanding the function of PITX2 in the adult left atrium, EU Training Network on Novel Targets and Methods in Atrial Fibrillation, G3147825888, G315582519, G4415518382, G4703545176, G4937468798, G5112197684, G6162339058, Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly, G6642301909, G7768472099, G8058140403, G8348474022, G8737466616
OpenAlex ID: W3045708564