Very long-term outcomes after a single catheter ablation procedure for the treatment of atrial fibrillation-the protective role of antiarrhythmic drug therapy.

Abstract

BACKGROUND:

Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but its long-term clinical outcomes, predictors of relapse, and optimal pharmacological treatment remain controversial.

OBJECTIVE:

The objectives of this paper were to (1) assess very long-term AF recurrence, (2) identify predictors of relapse, and (3) evaluate the impact of continued antiarrhythmic drug (AAD) treatment after ablation.

METHODS:

Multicenter observational registry including all consecutive patients with drug-resistant AF who underwent a first PVI between 2006 and 2008 (n = 253 (age 55 years (IQR 48-63)), 80% males, 64% with paroxysmal AF. Endpoint was AF/AT/AFL relapse after a 3-month blanking period. Predictors and protective factors of AF relapse were assessed with multivariate Cox regression.

RESULTS:

A total of 144 patients (57%) relapsed over a median 5-year (IQR 2-9) follow-up-annual relapse rate of 10%/year. Female sex (aHR 1.526, 95% CI 1.037-2.246, P = 0.032), non-paroxysmal AF (aHR 1.410, 95% CI 1.000-1.987, P = 0.050), and LA volume/BSA (aHR 1.012, 95% CI 1.003-1.021, P = 0.008) were identified as independent predictors of relapse. A total of 139 patients (55%) continued AAD (55% on amiodarone) after blanking period. One-year overall PVI success rate of patients under AAD was 86 vs 76% with no AAD (P < 0.001)-annual relapse rates were 8%/year vs 14%/year (P < 0.001), respectively. AAD was associated with a long-term reduction in AF relapse (aHR 0.673, 95% CI 0.509-0.904 P = 0.004).

CONCLUSION:

Half the patients remained free from AF 5 years after a single procedure. Female sex, non-paroxysmal AF, and LA volume/BSA independently predicted recurrence, whereas continuing AAD after the 3-month blanking period reduced relapse. In a multicenter registry of AF patients undergoing a first PVI, 57% relapsed over a median 5-year follow-up. Female sex, non-paroxysmal AF and LA volume/BSA were identified as independent predictors of relapse. Maintaining AAD therapy after the blanking period was associated with a long-term reduction in AF relapse.

• Authors: João Mesquita, Diogo Cavaco, António Miguel Ferreira, Francisco Moscoso Costa, Pedro Carmo, Francisco Morgado, Miguel Mendes, Pedro Adragão
• Journal: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (J Interv Card Electrophysiol) Vol. 52 Issue 1 Pg. 39-45 (Jun 2018) ISSN: 1572-8595 [Electronic] Netherlands
• PMID: 29511973 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

• Anti-Arrhythmia Agents

Topics

• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (diagnostic imaging, drug therapy, surgery)
• Catheter Ablation (adverse effects, methods)
• Combined Modality Therapy
• Electrocardiography (methods)
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Proportional Hazards Models
• Pulmonary Veins (surgery)
• Recurrence
• Registries
• Risk Assessment
• Severity of Illness Index
• Time
• Treatment Outcome