Differential effect of arrhythmia history in patients with persistent compared to paroxysmal atrial fibrillation on recurrence after pulmonary vein isolation
D Kranyak, A Novak, N Pataky, L Kazareczki, A Benak, G Bencsik, A Makai, M Miklos, M Vamos, L Saghy, T Szili-Torok, R PapAbstract
Introduction
Longer duration of atrial fibrillation (AF) history before undergoing pulmonary vein isolation (PVI) is a recognized predictor of recurrence. Whether the effect is similar in both paroxysmal and persistent AF patients is not clarified.
Methods
We retrospectively analysed clinical and procedural data of patients undergoing first PVI, using point-by-point radiofrequency (RF) technology between 2013 and 2024.
Results
During the study period, 1414 patients underwent point-by-point RF PVI (60.5 % male, mean age 62.3 ± 10.6 years), whose AF history was available (65% paroxysmal AF). Duration of AF history was longer in patients with paroxysmal (4.9±5.5 years), compared to persistent AF (3.6±4.5 years, p‹0.01), and correlated with increasing age (p‹0.01), but not with other clinical parameters. During 25±26 months of follow-up 423 (30%) patients experienced recurrent arrhythmia. AF history was longer in patients with, compared to without recurrence after PVI for persistent AF (5.1±10.2 vs. 3.2±4.1 years, p‹0.01), but there was no such association in the paroxysmal AF group (p=0.43). Persistent AF predicted recurrence in the total population, but AF history was an independent predictor only among persistent AF patients (OR 1.1, 95%CI 1.01-1.19, p=0.025). Receiver operating curve analysis identified an AF history of ≥2 years to best predict recurrence. Kaplan-Meier survival analysis demonstrated better recurrence free survival in patients with an AF history ‹2 years in the persistent group (p‹0.01), but not among paroxysmal patients (p=0.29).
Conclusion
The duration of AF history predicts the outcome of PVI in persistent, but not in paroxysmal AF. These results underline the necessity of a timely intervention, preferably within 2 years of diagnosis, in persistent AF. The procedure is less urgent if the arrhythmia is paroxysmal.