Abstract 659 Early arrhythmia recurrence predicts single- and multiprocedural outcomes after catheter ablation for persistent atrial fibrillation

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Early arrhythmia recurrence predicts single- and multiprocedural outcomes after catheter ablation for persistent atrial fibrillation
M.-A. Popa¹, M. Kottmaier¹, E. Risse¹, M. Telishevska¹, S. Lengauer¹, M. Kornmayer¹, S. Ulrich¹, T. Reents¹, I. Deisenhofer¹, G. Heßling¹, F. Bourier¹
¹Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München;
Background Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). ERAT is associated with late recurrence (LR) in paroxysmal AF but data about its significance after persistent AF ablation is scarce. We sought to characterize ERAT after RFCA for persistent AF and to analyze its predictive value for single- and multiprocedural long-term outcomes. Methods The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) undergoing their first RFCA for persistent AF using a „modified stepwise approach” (PVI ± CFAE ± linear lesions). All patients remained off antiarrhythmic drugs (AAD). ERAT was defined as any atrial arrhythmia ≥30 seconds occurring within the first 30 days. LR was determined during follow-up visits scheduled 1, 3, 6 and 12 months post ablation using 7-day-Holter ECGs. Results ERAT occurred in 143/207 (69.1%) patients, presented as AF (60%) or AT (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.4% vs. 43.7%, P<0.001). LR rate was 95.2%, 87.5%, 83.3% and 100% if ERAT first occurred in week 1, 2, 3 and 4. On multivariate analysis, ERAT was a strong independent predictor for LR (OR 15.1, P <0.001). The only negative predictor for LR was intraprocedural termination to sinus rhythm (OR 0.25, P=0.03). On Kaplan-Meier analysis, freedom from any arrhythmia off AAD after multiple procedures was 47.5% vs. 73.4% (log rank P<0.001) in patients with and without ERAT. Extending the blanking period from 30 to 90 days did not significantly impact LR rates. Conclusion ERAT occurring during the first month after RFCA for persistent AF off AAD is a strong independent predictor for LR, thus challenging the notion that ERAT is a transient phenomenon. Our data provides evidence that limiting the post-ablation blanking period to 30 days is meaningful. Future studies should address the benefit of early re-ablation after persistent AF ablation.
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