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Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation
Prediction of recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. We sought to investigate the long-term outcomes after AF catheter ablation. A total of 2221 consecutive patients who underwent catheter ablation for symptomatic AF were included in this study (mean age...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601892/ https://www.ncbi.nlm.nih.gov/pubmed/33007810 http://dx.doi.org/10.3390/jcm9103164 |
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author | Baek, Yong-Soo Choi, Jong-Il Kim, Yun Gi Lee, Kwang-No Roh, Seung-Young Ahn, Jinhee Kim, Dong-Hyeok Lee, Dae In Hwang, Sung Ho Shim, Jaemin Kim, Jin Seok Kim, Dae-Hyeok Park, Sang-Weon Kim, Young-Hoon |
author_facet | Baek, Yong-Soo Choi, Jong-Il Kim, Yun Gi Lee, Kwang-No Roh, Seung-Young Ahn, Jinhee Kim, Dong-Hyeok Lee, Dae In Hwang, Sung Ho Shim, Jaemin Kim, Jin Seok Kim, Dae-Hyeok Park, Sang-Weon Kim, Young-Hoon |
author_sort | Baek, Yong-Soo |
collection | PubMed |
description | Prediction of recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. We sought to investigate the long-term outcomes after AF catheter ablation. A total of 2221 consecutive patients who underwent catheter ablation for symptomatic AF were included in this study (mean age 55 ± 11 years, 20.3% women, and 59.0% paroxysmal AF). Extensive ablation, in addition to circumferential pulmonary vein isolation, was more often accomplished in patients with non-paroxysmal AF than in those with paroxysmal AF (87.4% vs. 25.3%, p < 0.001). During a median follow-up of 54 months, sinus rhythm (SR) was maintained in 67.1% after index procedure. After redo procedures in 418 patients, 83.3% exhibited SR maintenance. Recurrence rates were similar for single and multiple procedures (17.4% vs. 16.7%, p = 0.765). Subanalysis showed that the extent of late gadolinium enhancement (LGE), as assessed by cardiac magnetic resonance, is greater in patients with recurrence than in those without recurrence (36.2 ± 23.9% vs. 21.8 ± 13.7%, p < 0.001). Cox-regression analysis revealed that non-paroxysmal AF (hazard ratio (HR) 2.238, 95% confidence interval (CI) 1.905–2.629, p < 0.001), overweight (HR 1.314, 95% CI 1.107–1.559, p = 0.020), left atrium dimension ≥ 45 mm (HR 1.284, 95% CI 1.085–1.518, p = 0.004), AF duration (HR 1.020 per year, 95% CI 1.006–1.034, p = 0.004), and LGE ≥ 25% (HR 1.726, 95% CI 1.330–2.239, p < 0.001) are significantly associated with AF recurrence after catheter ablation. This study showed that repeated catheter ablation improves the clinical outcomes of patients with non-paroxysmal AF, suggesting that AF substrate based on LGE may underpin the mechanism of recurrence after catheter ablation. |
format | Online Article Text |
id | pubmed-7601892 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-76018922020-11-01 Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation Baek, Yong-Soo Choi, Jong-Il Kim, Yun Gi Lee, Kwang-No Roh, Seung-Young Ahn, Jinhee Kim, Dong-Hyeok Lee, Dae In Hwang, Sung Ho Shim, Jaemin Kim, Jin Seok Kim, Dae-Hyeok Park, Sang-Weon Kim, Young-Hoon J Clin Med Article Prediction of recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. We sought to investigate the long-term outcomes after AF catheter ablation. A total of 2221 consecutive patients who underwent catheter ablation for symptomatic AF were included in this study (mean age 55 ± 11 years, 20.3% women, and 59.0% paroxysmal AF). Extensive ablation, in addition to circumferential pulmonary vein isolation, was more often accomplished in patients with non-paroxysmal AF than in those with paroxysmal AF (87.4% vs. 25.3%, p < 0.001). During a median follow-up of 54 months, sinus rhythm (SR) was maintained in 67.1% after index procedure. After redo procedures in 418 patients, 83.3% exhibited SR maintenance. Recurrence rates were similar for single and multiple procedures (17.4% vs. 16.7%, p = 0.765). Subanalysis showed that the extent of late gadolinium enhancement (LGE), as assessed by cardiac magnetic resonance, is greater in patients with recurrence than in those without recurrence (36.2 ± 23.9% vs. 21.8 ± 13.7%, p < 0.001). Cox-regression analysis revealed that non-paroxysmal AF (hazard ratio (HR) 2.238, 95% confidence interval (CI) 1.905–2.629, p < 0.001), overweight (HR 1.314, 95% CI 1.107–1.559, p = 0.020), left atrium dimension ≥ 45 mm (HR 1.284, 95% CI 1.085–1.518, p = 0.004), AF duration (HR 1.020 per year, 95% CI 1.006–1.034, p = 0.004), and LGE ≥ 25% (HR 1.726, 95% CI 1.330–2.239, p < 0.001) are significantly associated with AF recurrence after catheter ablation. This study showed that repeated catheter ablation improves the clinical outcomes of patients with non-paroxysmal AF, suggesting that AF substrate based on LGE may underpin the mechanism of recurrence after catheter ablation. MDPI 2020-09-30 /pmc/articles/PMC7601892/ /pubmed/33007810 http://dx.doi.org/10.3390/jcm9103164 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Baek, Yong-Soo Choi, Jong-Il Kim, Yun Gi Lee, Kwang-No Roh, Seung-Young Ahn, Jinhee Kim, Dong-Hyeok Lee, Dae In Hwang, Sung Ho Shim, Jaemin Kim, Jin Seok Kim, Dae-Hyeok Park, Sang-Weon Kim, Young-Hoon Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation |
title | Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation |
title_full | Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation |
title_fullStr | Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation |
title_full_unstemmed | Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation |
title_short | Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation |
title_sort | atrial substrate underlies the recurrence after catheter ablation in patients with atrial fibrillation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601892/ https://www.ncbi.nlm.nih.gov/pubmed/33007810 http://dx.doi.org/10.3390/jcm9103164 |
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