Pre-ablation rhythm as a determinant of af recurrence: a multicenter prospective analysis
E Massalha, F Haskiah, I Marai, Y Michowits, M Glikson, Y Konstantino, M Haim, D Luria, A Omelchenko, A Laish-Farkash, M Suleiman, R Beinart, E NofAbstract
Background
Pulmonary vein isolation (PVI) is increasingly recognized as a cornerstone treatment for paroxysmal and persistent atrial fibrillation (AF). Despite its growing usage, a notable number of patients experience arrhythmia recurrence.
Aims
To determine whether pre-procedural rhythm status impacts recurrence rates and clinical outcomes in AF patients treated with PVI.
Methods
Data were drawn from the Israeli Catheter Ablation Registry (ICAR), a prospective, multicenter registry of AF ablations conducted at 14 centers between January 2019 and December 2021. Patients were divided into two groups based on rhythm at the time of ablation: sinus rhythm and non-sinus rhythm. Baseline characteristics, procedural details, and follow-up data,including AF recurrence and hospitalization rates were prospectively collected. The primary outcome was post-blanking AF recurrence within a 2-year follow-up period.
Results
Among 1002 patients, 674 (67.3%) were in sinus rhythm and 328 (32.7%) in non-sinus rhythm at the time of PVI. Patients in sinus rhythm were younger (63.2 ±11.8 vs. 65.7 ±9.9 years, p<0.01), had higher left ventricular ejection fraction (LVEF) (56.1±9.2 vs. 51.0 ±12.1, p<0.01), and more commonly had paroxysmal AF (83.0% vs. 29.1%, p<0.01). The sinus rhythm group experienced significantly lower AF recurrence rates at 2 years (18.7% vs. 24.7%, p=0.03) and fewer hospitalizations (15.0% vs. 23.5%, p=0.001). A Multivariable COX proportional hazard regression model showed that non-sinus rhythm at PVI was independently associated with higher 1-year AF recurrence rates (HR 1.64, 95% CI [1.08-2.48], p=0.02).
Conclusion
Patients in sinus rhythm at the time of PVI exhibited lower AF recurrence rates and reduced hospitalization. These findings support a treatment approach focused on achieving and maintaining sinus rhythm before PVI to optimize outcomes in AF patients.