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Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome
AIMS: Atrial fibrillation (AF) is a chronic progressive disease that continuously recurs even after successful AF catheter ablation (AFCA). We explored the mechanism of long-term recurrence by comparing patient characteristics and redo-ablation findings. METHODS AND RESULTS: Among the 4248 patients...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228616/ https://www.ncbi.nlm.nih.gov/pubmed/37099677 http://dx.doi.org/10.1093/europace/euad113 |
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author | Choi, Sung Hwa Yu, Hee Tae Kim, Daehoon Park, Je-Wook Kim, Tae-Hoon Uhm, Jae-Sun Joung, Boyoung Lee, Moon-Hyoung Hwang, Chun Pak, Hui-Nam |
author_facet | Choi, Sung Hwa Yu, Hee Tae Kim, Daehoon Park, Je-Wook Kim, Tae-Hoon Uhm, Jae-Sun Joung, Boyoung Lee, Moon-Hyoung Hwang, Chun Pak, Hui-Nam |
author_sort | Choi, Sung Hwa |
collection | PubMed |
description | AIMS: Atrial fibrillation (AF) is a chronic progressive disease that continuously recurs even after successful AF catheter ablation (AFCA). We explored the mechanism of long-term recurrence by comparing patient characteristics and redo-ablation findings. METHODS AND RESULTS: Among the 4248 patients who underwent a de novo AFCA and protocol-based rhythm follow-up at a single centre, we enrolled 1417 patients [71.7% male, aged 60.0 (52.0–67.0) years, 57.9% paroxysmal AF] who experienced clinical recurrences (CRs), and divided them according to the period of recurrence: within one year (n = 645), 1–2 years (n = 339), 2–5 years (n = 308), and after 5 years (CR(>5) (yr), n = 125). We also compared the redo-mapping and ablation outcomes of 198 patients. In patients with CR(>5) (yr), the proportion of paroxysmal AF was higher (P = 0.031); however, the left atrial (LA) volume (quantified by computed tomography, P = 0.003), LA voltage (P = 0.003), frequency of early recurrence (P < 0.001), and use of post-procedure anti-arrhythmic drugs (P < 0.001) were lower. A CR(>5) (yr) was independently associated with a low LA volume [odds ratio (OR) 0.99 (0.98–1.00), P = 0.035], low LA voltage [OR 0.61 (0.38–0.94), P = 0.032], and lower early recurrence [OR 0.40 (0.23–0.67), P < 0.001]. Extra-pulmonary vein triggers during repeat procedures were significantly greater in patients with a CR(>5) (yr), despite no difference in the de novo protocol (P for trend 0.003). The rhythm outcomes of repeat ablation procedures did not differ according to the timing of the CR (log-rank P = 0.330). CONCLUSIONS: Patients with a later CR exhibited a smaller LA volume, lower LA voltage, and higher extra-pulmonary vein triggers during the repeat procedure, suggesting AF progression. |
format | Online Article Text |
id | pubmed-10228616 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-102286162023-05-31 Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome Choi, Sung Hwa Yu, Hee Tae Kim, Daehoon Park, Je-Wook Kim, Tae-Hoon Uhm, Jae-Sun Joung, Boyoung Lee, Moon-Hyoung Hwang, Chun Pak, Hui-Nam Europace Clinical Research AIMS: Atrial fibrillation (AF) is a chronic progressive disease that continuously recurs even after successful AF catheter ablation (AFCA). We explored the mechanism of long-term recurrence by comparing patient characteristics and redo-ablation findings. METHODS AND RESULTS: Among the 4248 patients who underwent a de novo AFCA and protocol-based rhythm follow-up at a single centre, we enrolled 1417 patients [71.7% male, aged 60.0 (52.0–67.0) years, 57.9% paroxysmal AF] who experienced clinical recurrences (CRs), and divided them according to the period of recurrence: within one year (n = 645), 1–2 years (n = 339), 2–5 years (n = 308), and after 5 years (CR(>5) (yr), n = 125). We also compared the redo-mapping and ablation outcomes of 198 patients. In patients with CR(>5) (yr), the proportion of paroxysmal AF was higher (P = 0.031); however, the left atrial (LA) volume (quantified by computed tomography, P = 0.003), LA voltage (P = 0.003), frequency of early recurrence (P < 0.001), and use of post-procedure anti-arrhythmic drugs (P < 0.001) were lower. A CR(>5) (yr) was independently associated with a low LA volume [odds ratio (OR) 0.99 (0.98–1.00), P = 0.035], low LA voltage [OR 0.61 (0.38–0.94), P = 0.032], and lower early recurrence [OR 0.40 (0.23–0.67), P < 0.001]. Extra-pulmonary vein triggers during repeat procedures were significantly greater in patients with a CR(>5) (yr), despite no difference in the de novo protocol (P for trend 0.003). The rhythm outcomes of repeat ablation procedures did not differ according to the timing of the CR (log-rank P = 0.330). CONCLUSIONS: Patients with a later CR exhibited a smaller LA volume, lower LA voltage, and higher extra-pulmonary vein triggers during the repeat procedure, suggesting AF progression. Oxford University Press 2023-04-26 /pmc/articles/PMC10228616/ /pubmed/37099677 http://dx.doi.org/10.1093/europace/euad113 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Research Choi, Sung Hwa Yu, Hee Tae Kim, Daehoon Park, Je-Wook Kim, Tae-Hoon Uhm, Jae-Sun Joung, Boyoung Lee, Moon-Hyoung Hwang, Chun Pak, Hui-Nam Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome |
title | Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome |
title_full | Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome |
title_fullStr | Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome |
title_full_unstemmed | Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome |
title_short | Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome |
title_sort | late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228616/ https://www.ncbi.nlm.nih.gov/pubmed/37099677 http://dx.doi.org/10.1093/europace/euad113 |
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