Abstract 1267 Prognostic significance of atrial tachycardia recurrence after catheter ablation for persistent atrial fibrillation

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Prognostic significance of atrial tachycardia recurrence after catheter ablation for persistent atrial fibrillation
M.-A. Popa¹, F. Bourier¹, T. Reents¹, M. Kottmaier¹, S. Lengauer¹, M. Telishevska¹, S. J. Maurer¹, H. Krafft¹, E. Risse¹, F. Bahlke¹, F. Englert¹, G. Heßling¹, I. Deisenhofer¹
¹Elektrophysiologie, Deutsches Herzzentrum München, München;
Background: Arrhythmia recurrence after catheter ablation for persistent atrial fibrillation is common and can manifest as atrial fibrillation (AF) or atrial tachycardia (AT). It is unclear how the transition of AF to AT after initial AF ablation impacts outcomes. This study sought to determine the prognostic significance of AT recurrence after persistent AF ablation for long-term outcomes following re-ablation. Methods: We investigated 132 consecutive patients (67.5 ± 9.8 years, 61.4% male, CHA₂DS₂-VASc score 2.7 ± 1.4) with documented atrial arrhythmia recurrence ≥ 3 months after index ablation for persistent AF who were referred for a second ablation. Three groups were defined according to initial rhythm presentation at the beginning of re-ablation: AF (n=70; group 1), AT (n=34; group 2) and sinus rhythm (n=28; group 3). Patients in sinus rhythm had documented paroxysmal AF or AT. The second ablation procedure included a redo pulmonary vein isolation (PVI) in case of documented PV reconnection, linear lesions for intraprocedural ATs with macro-reentrant circuit and substrate ablation in case of AF. Patients were followed up for a median of 30.3 months (IQR 17.0; 43.6). Results: Re-ablation was performed after a median of 149 days (IQR 89.3; 399.0) following index ablation. The ablation comprised redo PVI in n=106 (80.3%), linear lesions in n=78 (59.1%) and substrate ablation in n=81 (61.4%) patients. The most common AT type was roof-dependent (n=13; 38.2%), followed by perimitral AT (n=9, 26.5%) and localized reentries (n=8, 23.5%). Recurrence rates of any atrial arrhythmia 24 months after re-ablation were 82.9% in group 1, 61.8% in group 2 and 57.1% in group 3 (p=0.012). On Kaplan-Meier analysis, freedom of any atrial arrhythmia was significantly higher in groups 2 and 3 after re-ablation (Log Rank p=0.004) and after multiple ablations (Log Rank p=0.001). On multivariate analysis, recurrent persistent AF after the index ablation (OR 5.1, p=0.017) and female gender (OR 4.4, p=0.022) were independently associated with arrhythmia recurrence following re-ablation. Conclusion: Recurrence of atrial tachycardia after index ablation for persistent AF is associated with superior long-term outcomes following re-ablation.
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