Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

Matthias Daniel Zink, Winnie Chua, Stef Zeemering, Luigi di Biase, Bayes de Luna Antoni, Callans David, Gerhard Hindricks, Karl Georg Haeusler, Hussein R. Al-Khalidi, Jonathan P. Piccini, Lluís Mont, Jens Cosedis Nielsen, Luis Alberto Escobar, Joseph de Bono, Isabelle C. Van Gelder, Tom de Potter, Daniel Scherr, Sakis Themistoclakis, Derick Todd, Paulus KirchhofUlrich Schotten

Research output: Contribution to journalArticle

Abstract

AIMS: Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50-70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. METHODS AND RESULTS: We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA-AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93-2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20-2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26-2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00-1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). CONCLUSION: Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02227550.

Keywords

  • Ablation
  • Apixaban
  • Atrial fibrillation
  • AXAFA
  • Blanking period
  • Early recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Zink, M. D., Chua, W., Zeemering, S., di Biase, L., Antoni, B. D. L., David, C., Hindricks, G., Haeusler, K. G., Al-Khalidi, H. R., Piccini, J. P., Mont, L., Nielsen, J. C., Escobar, L. A., de Bono, J., Van Gelder, I. C., de Potter, T., Scherr, D., Themistoclakis, S., Todd, D., ... Schotten, U. (2020). Predictors of recurrence of atrial fibrillation within the first 3 months after ablation. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 22(9), 1337-1344. https://doi.org/10.1093/europace/euaa132