Predictors of recurrence of atrial fibrillation within the first 3 months after ablation
Zink, Matthias Daniel (Cardiovascular Research Institute Maastricht (CARIM))
Chua, Winnie (University of Birmingham)
Zeemering, Stef (Cardiovascular Research Institute Maastricht (CARIM))
Di Biase, Luigi (Albert Einstein College of Medicine at Montefiore Hospital)
Antoni, Bayes de Luna (Institut d'Investigació Biomèdica Sant Pau)
David, Callans (Hospital of the University of Pennsylvania)
Hindricks, Gerhard (University of Leipzig)
Haeusler, Karl Georg (University Hospital Würzburg)
Al-Khalidi, Hussein R. (Duke University Medical Center, Duke Clinical Research Institute)
Piccini, Jonathan P. (Duke University Medical Center)
Mont, Lluís (Hospital Clínic i Provincial de Barcelona)
Nielsen, Jens Cosedis (Aarhus University Hospital (Aarhus, Dinamarca))
Escobar, Luis Alberto (Institut d'Investigació Biomèdica Sant Pau)
de Bono, Joseph (Birmingham Women's and Children's Hospital (Regne Unit))
Van Gelder, Isabelle C. (UMCG Thorax Center, University of Groningen)
de Potter, Tom (Cardiovascular Center)
Scherr, Daniel (Cardiovascular Research Institute Maastricht (CARIM))
Themistoclakis, Sakis (Unit of Electrophysiology and Cardiac Pacing, Dell'Angelo Hospital)
Todd, Derick (Liverpool Heart and Chest Hospital)
Kirchhof, Paulus (Institute of Cardiovascular Sciences, University of Birmingham)
Schotten, Ulrich (Cardiovascular Research Institute Maastricht (CARIM))
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	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. 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). 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. Clinicaltrials. gov identifier NCT02227550.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Atrial fibrillation ; Ablation ; AXAFA ; Early recurrence ; Blanking period ; Apixaban
Published in:	Europace, Vol. 22 (july 2020) , p. 1337-1344, ISSN 1532-2092

DOI: 10.1093/europace/euaa132
PMID: 32725107

8 p, 366.3 KB

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