Predictive value of acute arrhythmia termination during persistent atrial fibrillation ablation
J Llau Garcia, I Llorente Lipe, M Martinez Perez, M Sanz-Berbegal, M T Izquierdo De Francisco, J Navarro Manchon, I Hernandez-Romero, O Cano Perez, J Navarrete Navarro, C Arveras Martinez, A M Climent, M S Guillem, J Osca AsensiAbstract
Introduction
In patients with persistent Atrial Fibrillation (AF), recurrence rates after a first ablation procedure remain high, ranging between 25% and 55%. This highlights the need for procedural markers, like acute AF termination without needing electric cardioversion, that can predict ablation success and guide substrate-targeted therapy.
Objective
To assess whether acute AF termination during ablation consistently predicts freedom from recurrence.
Methods
A total of 44 patients referred for the first catheter ablation procedure of persistent atrial fibrillation were prospectively studied. All procedures included pulmonary vein isolation (PVI) and posterior wall ablation with pulsed field ablation.
Patients were followed at 6 and 12 months using 30-day Holter monitoring. Those with documented AF recurrence on ECG before the follow-up visit were not re-monitored with Holter.
Results
No statistically significant differences were found between patients with and without recurrence in demographic or clinical variables (Figure 1).
During follow-up, 19 patients (43.2%) experienced AF recurrence, of which 11 (25.0%) were clinical and 8 (18.2%) were subclinical. 13 of them (29.5%) were persistent and 6 (13.6%) were paroxysmal.
Of the 44 patients, 8 experienced acute AF termination during ablation, either converting to sinus rhythm or organizing into atrial flutter. In these cases, mapping and ablation of the flutter were also performed. When analysed separately (figure 2), none of the patients with acute AF termination experienced recurrence as persistent AF, whereas 13 of the 36 patients without termination did (p = 0.045). In a multivariate survival analysis, evolution time of AF was identified as a predictor of recurrence, while acute termination approached significance (p = 0.061).
Conclusions
Acute AF termination during ablation occurs in a minority of persistent AF patients and may indicate protection against recurrence as persistent AF. Randomised studies comparing an ablation strategy aimed at achieving acute AF termination versus a conventional approach are warranted to determine whether this strategy improves outcomes.Clinical and demographic variablesSurvival Curve