Early arrhythmia recurrence as a determinant of long-term rhythm outcomes after atrial fibrillation and flutter ablation
F Lemos De Sousa, M L Moura, F Nunes, I Rodrigues, A Goncalves, M C Almeida, R Teixeira, J Almeida, M Almeida, R Fontes CarvalhoAbstract
Background
Catheter ablation is an effective strategy for rhythm control in atrial fibrillation (AF) and atrial flutter (AFL); however, long-term success remains limited by late arrhythmia recurrence. Several clinical and structural factors may influence outcomes, but their individual prognostic impact is not fully established.
Purpose
To evaluate whether early AF/AFL recurrence during the blanking period (<90 days) predicts late recurrence and to identify additional clinical and structural predictors following catheter ablation.
Methods
This retrospective cohort study included consecutive patients who underwent AF/AFL ablation between 2017 and 2021. Baseline demographic data, comorbidities, arrhythmia characteristics, atrial dimensions and procedural variables were collected. Early recurrence was defined as AF/AFL occurring within 90 days after ablation, and late recurrence as arrhythmia documented ≥90 days post-procedure. Predictors of late recurrence were assessed using Cox proportional hazards models, incorporating variables with p<0.10 in univariate analysis or deemed clinically relevant.
Results
A total of 767 patients were analyzed, with a mean age of 58±11 years; 275 (35.9%) were women and 592 (77.2%) had paroxysmal AF. Early AF/AFL recurrence occurred in 94 patients (12.2%). During a median follow-up of 25.3 months (IQR 17.3–36.7), late recurrence was documented in 202 patients (26.3%). In multivariable analysis, early recurrence emerged as the strongest independent predictor of late recurrence (HR 4.37; 95% CI 3.12–6.12; p<0.001). Female sex was also associated with a higher risk of recurrence (HR 1.57; 95% CI 1.14–2.16; p=0.006). Longer duration of AF since diagnosis (HR 1.04 per year; 95% CI 1.00–1.08; p=0.049) and increased left atrial diameter (HR 1.03 per mm; 95% CI 1.00–1.06; p=0.050) were additional predictors, while age was not significantly associated with late recurrence (p=0.960).
Conclusions
Early AF/AFL recurrence during the blanking period is a powerful independent predictor of late arrhythmia recurrence after catheter ablation. Female sex, longer AF duration and larger left atrial size further contribute to risk stratification, whereas age does not appear to influence long-term outcomes. These findings underscore the prognostic importance of early post-ablation rhythm monitoring and support close follow-up during the blanking period.