Incidence, characteristics, and prognostic significance of early recurrences after different ablation approaches for persistent atrial fibrillation

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-11-01 Epub Date: 2024-12-30 DOI:10.1016/j.hrthm.2024.12.031

Sohaib A. Virk BMed/MD, MMed (ClinEpi) , David Chieng MBBS, PhD , Louise Segan MBBS , Joseph B. Morton MBBS, PhD , Geoffrey Lee MBCHD, PhD , Paul Sparks MBBS, PhD , Alex J. McLellan MBBS, PhD , Hariharan Sugumar MBBS, PhD , Sandeep Prabhu MBBS, PhD , Liang-Han Ling MBBS, PhD , Aleksandr Voskoboinik MBBS, PhD , Rajeev K. Pathak MBBS, PhD , Laurence D. Sterns MD, FHRS , Matthew Ginks MD , Prashanthan Sanders MBBS, PhD, FHRS , Peter Kistler MBBS, PhD, FHRS , Jonathan Kalman MBBS, PhD, FHRS

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Abstract

Background

Early recurrence of atrial tachyarrhythmia (ERAT) is common after catheter ablation of atrial fibrillation (AF). The specific clinical and arrhythmia characteristics of ERAT influencing late recurrence risk in persistent AF are unclear. In addition, the impact of different ablation strategies on the incidence and prognostic significance of ERAT remains unknown.

Objective

This study aimed to assess the incidence, characteristics, and prognostic impact of ERAT in patients with persistent AF undergoing pulmonary vein isolation alone or pulmonary vein isolation with posterior wall isolation.

Methods

Trial participants monitored by implantable cardiac devices or twice-daily electrocardiogram transmissions were included. Atrial arrhythmia recurrences lasting ≥30 seconds were classified as ERAT (within 3 months after ablation) or late recurrence (between 3 and 12 months).

Results

Of the 282 included patients, ERAT occurred in 124 (44.0%). ERAT portended an increased incidence of late recurrence (68.5% vs 32.9%; hazard ratio, 3.36; 95% confidence interval, 2.35–4.79) and significantly higher post–blanking period AF burden (median, 0.66% [interquartile range, 0–8.35%] vs 0% [0–0.55%]). The hazard ratio for late recurrence was 2.34 (1.48–3.71), 2.89 (1.63–5.12), and 6.00 (3.86–9.32) when the latest ERAT occurred in the first, second, and third month, respectively. Late recurrence risk was particularly elevated in patients with high-burden, frequent, or symptomatic ERAT. Ablation strategy did not affect the incidence, burden, arrhythmia characteristics, or prognostic significance of ERAT.

Conclusion

ERAT after radiofrequency ablation of persistent AF is an independent predictor of late recurrence and increased post–blanking period AF burden. An individualized assessment of early recurrences is warranted to critically evaluate their clinical significance.

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持续性房颤不同消融方式早期复发的发生率、特点及预后意义。

背景：房颤（AF）导管消融后早期复发房性心动过速（ERAT）很常见。ERAT影响持续性房颤晚期复发风险的具体临床和心律失常特征尚不清楚。此外，不同消融策略对ERAT发病率和预后意义的影响尚不清楚。目的：本研究旨在评估持续性房颤患者在CAPLA中单独进行肺静脉隔离（PVI）或PVI合并后壁隔离（PWI）的发生率、特征和预后影响（导管消融治疗持续性房颤：PVI与PVI合并PWI的多中心随机试验）。方法：通过植入心脏装置或每日两次心电图传输监测的试验参与者包括在内。房性心律失常复发持续bbb30秒分为ERAT（消融后3个月内）或晚期复发（3-12个月）。结果：282例患者中，ERAT发生率124例（44.0%）。ERAT预示晚期复发率增加(68.5% vs. 32.9%；人力资源3.36;95% CI 2.35-4.79)和显著更高的空白期后AF负担（中位数0.66%[IQR, 0-8.35%] vs. 0%[0-0.55%]）。晚期复发的HR分别为2.34 （95% CI 1.48 ~ 3.71）、2.89 （95% CI 1.63 ~ 5.12）和6.00 (95% CI 3.86 ~ 9.32)，分别发生在第1个月、第2个月和第3个月。在高负担、频繁或有症状的ERAT患者中，晚期复发风险特别高。消融策略不影响ERAT的发生率、负担、心律失常特征或预后意义。结论：射频消融后持续性房颤的ERAT是房颤晚期复发和消融期房颤负担增加的独立预测因子。早期复发的个体化评估是必要的，以严格评估其临床意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.