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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
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.
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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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