Predictors of long-term atrial fibrillation recurrence following catheter ablation: a UK multicenter study
N Chandan, H Hussein, Z Borawska, A Balaji, M Elsayed, T Muddasar, R Frazer, D Al-Amodi, S M Z Rahim, T Lachlan, A Lewko, G McGregor, F OsmanAbstract
Background
Catheter ablation for atrial fibrillation (AF) is superior to antiarrhythmic medication, but long-term AF recurrence post-AF ablation remains common.
Purpose
Evaluate predictors of AF recurrence at long-term follow-up post-ablation.
Methods
Retrospective cohort study of all consecutive AF ablation procedures performed across four UK AF ablation hospitals between Jan 2018-June 2023. Baseline characteristics (including AF subtype/comorbidities/medications), procedural details/complications were collected. Atrial arrhythmia recurrences during follow-up were noted. Multivariate Cox regression was used to identify predictors of recurrence.
Results
A total of 1,061 patients underwent 1,155 ablation procedures. Mean age was 63±11years with 393 (37%) females. Paroxysmal AF (PAF) was present in 592 (55.8%) and persistent AF (including long-standing persistent AF) in 469 (44.2%). Hypertension, diabetes, and coronary disease were present in 42.2%, 11.6%, and 9.5% respectively. Most (81.5%) had preserved left ventricular ejection fraction, and 58.2% had non-dilated left atria (LA). Cryoballoon ablation was performed in 79.3%, with the remainder undergoing radio-frequency point-by-point ablation; 219 (19%) were redo AF-ablations. The median follow-up duration was 3.3 years (IQR:1.8–5.1 years). AF recurrence rates were 23.7%, 39.2% and 73.6% at 1-, 2- and 5-years, respectively. AF subtype (persistent AF hazard ratio (HR):1.68; long-standing persistent AF HR:2.23, both p<0.001) and severe LA dilatation (HR:1.45, p=0.003) independently predicted recurrence in the total AF cohort. Moderate and severe LA dilatation were independent predictors of recurrence only in persistent AF (HR:1.58, p=0.01 and HR:1.64, p<0.001, respectively), while amiodarone use at time of AF ablation predicted reduced atrial arrhythmia recurrence in both PAF (HR:0.49, p=0.04) and persistent AF (HR:0.74, p=0.02).
Conclusions
AF subtype and baseline LA volume were independent predictors of AF recurrence at long-term follow-up. Moderate-to-severe LA dilatation predicted recurrence in persistent AF but not PAF. Early post-procedure use of amiodarone lowered atrial arrhythmia recurrence irrespective of AF subtype.AF recurrence: LA dilatation & AF subtypeAF recurrence: Amiodarone use