Different Determinants of the Recurrence of Atrial Fibrillation and Adverse Clinical Events in the Mid-Term Period After Atrial Fibrillation Ablation.

Abstract

BACKGROUND:

It is unclear whether there are differences in the clinical factors between atrial fibrillation (AF) recurrence and adverse clinical events (AEs), including stroke/transient ischemic attack (TIA), major bleeding, and death, after AF ablation.Methods and Results:We examined the data from a retrospective multicenter Japanese registry conducted at 24 cardiovascular centers between 2011 and 2017. Of the 3,451 patients (74.1% men; 63.3±10.3 years) who underwent AF ablation, 1,046 (30.3%) had AF recurrence and 224 (6.5%) suffered AEs (51 strokes/TIAs, 71 major bleeding events, and 36 deaths) over a median follow-up of 20.7 months. After multivariate adjustment, female sex, persistent and long-lasting persistent AF (vs. paroxysmal AF), and stepwise increased left atrial diameter (LAd) quartiles were significantly associated with post-ablation recurrences. A multivariate analysis revealed that an age ≥75 years (vs. <65 years), body weight <50 kg, diabetes, vascular disease, left ventricular (LV) ejection fraction <40% (vs. ≥50%), Lad ≥44 mm (vs. <36 mm), and creatinine clearance <50 mL/min were independently associated with AE incidences, but not with recurrences.

CONCLUSIONS:

This study disclosed different determinants of post-ablation recurrence and AEs. Female sex, persistent AF, and enlarged LAd were determinants of post-ablation recurrence, whereas an old age, comorbidities, and LV and renal dysfunction rather than post-ablation recurrence were AEs determinants. These findings will help determine ablation indications and post-ablation management.

• Authors: Ryuta Watanabe, Koichi Nagashima, Yuji Wakamatsu, Naoto Otsuka, Katsuaki Yokoyama, Naoya Matsumoto, Takayuki Otsuka, Shinya Suzuki, Akio Hirata, Masato Murakami, Mitsuru Takami, Masaomi Kimura, Hidehira Fukaya, Shiro Nakahara, Takeshi Kato, Hiroshi Hayashi, Yu-Ki Iwasaki, Wataru Shimizu, Ikutaro Nakajima, Tomoo Harada, Junjiroh Koyama, Ken Okumura, Michifumi Tokuda, Teiichi Yamane, Kojiro Tanimoto, Yukihiko Momiyama, Noriko Nonoguchi, Kyoko Soejima, Koichiro Ejima, Nobuhisa Hagiwara, Masahide Harada, Kazumasa Sonoda, Masaru Inoue, Koji Kumagai, Hidemori Hayashi, Yoshinao Yazaki, Kazuhiro Satomi, Yuji Watari, Yasuo Okumura, AF Ablation Frontier Registry Investigators
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 86 Issue 2 Pg. 233-242 (01 25 2022) ISSN: 1347-4820 [Electronic] Japan
• PMID: 34219078 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Atrial Fibrillation
• Catheter Ablation (adverse effects, methods)
• Female
• Hemorrhage (etiology)
• Humans
• Ischemic Attack, Transient (etiology)
• Male
• Recurrence
• Retrospective Studies
• Stroke (etiology)
• Treatment Outcome