Early recurrence after pulmonary vein isolation is associated with inferior long-term outcomes: Insights from a retrospective cohort study.
atrial fibrillation
blanking period
catheter ablation
early recurrence
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
15
04
2020
revised:
24
08
2020
accepted:
01
09
2020
pubmed:
9
9
2020
medline:
12
10
2021
entrez:
8
9
2020
Statut:
ppublish
Résumé
The aim of this retrospective cohort study was to assess the influence of early recurrence (ER) after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) on long-term outcomes and to identify clinical variables associated with ER. We retrospectively collected clinical and procedural data from 1285 patients with paroxysmal AF who underwent PVI from 2011 to 2016. Kaplan-Meier, receiver operating characteristic (ROC) curve, logistic and Cox regression analyses were performed to analyze the influence of ER on long-term outcomes. ER was observed in 13% of patients. Kaplan-Meier analyses showed significantly different outcomes in 1285 patients with and without ER (49% vs 74%, log rank P < .01) and in 286 patients in the subgroup that underwent reablation (44% vs 79%, log rank P < .01). The hazard ratio (HR) of ER was 1.7 within 48 hours (5% of patients), 2.7 within 1 month (5%), 3.0 within 2 months (2%), and 6.4 within 3 months (1%) for late recurrence (LR), P < .01. ROC analysis (area under the curve [AUC] = 0.79) resulted in 70.3% sensitivity and 74.2% specificity for a 14-day blanking period, and 53.1% sensitivity and 85.5% specificity for a 30-day blanking period. Female patients (odds ratio [OR] 1.69, P < .01) and those with diabetes (OR 1.95, P = .01) were at higher risk for ER. ER is observed in a substantial number of patients with paroxysmal AF after PVI and has a continuous direct effect on LR according to the timing of ER. Randomized trials are required to assess the safety and effects of reablations in a shortened blanking period on long-term outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1156-1164Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Das M, Wynn GJ, Morgan M, et al. Recurrence of atrial tachyarrhythmia during the second month of the blanking period is associated with more extensive pulmonary vein reconnection at repeat electrophysiology study. Circ Arrhythm Electrophysiol. 2015;8:846-852.
Calkins H, Kuck KH, Cappato R, et al. Heart Rhythm Society task force on catheter and surgical ablation of atrial fibrillation. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) task force on catheter and surgical ablation of atrial fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACA), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012;9:632-696.
Andrade JG, Khairy P, Macle L, et al. Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter sustained treatment of paroxysmal atrial fibrillation (STOP AF) trial. Circ Arrhythm Electrophysiol. 2014;7:69-75.
Willems S, Khairy P, Andrade JG, et al. Redefining the blanking period after catheter ablation for paroxysmal atrial fibrillation: insights form the ADVICE (adenosine following pulmonary vein isolation to target dormant conduction elimination) trial. Circ Arrhythm Electrophysiol. 2016;9:e003909.
von Olshausen G, Uijl A, Jensen-Urstad M, et al. Early recurrences of atrial tachyarrhythmias post pulmonary vein isolation. J Cardiovasc Electrophysiol. 2020;31:674-681.
Jaïs P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118:2498-2505.
Isaac TT, Dokainish H, Lakkis NM. Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data. Am Coll Cardiol. 2007;50:2021-2028.
Hseih MH, Chiou CW, Wen ZC, et al. Alterations of heart rate variability after radiofrequency catheter ablation of focal atrial fibrillation originating from pulmonary veins. Circulation. 1999;100:2237-2243.
Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation. 2004;109:327-334.
Oral H, Knight BP, Ozaydin M, et al. Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. J Am Coll Cardiol. 2002;40:100-104.
Grubman E, Pavri BB, Lyle S, Reynolds C, Denofrio D, Kocovic DZ. Histopathologic effects of radiofrequency catheter ablation in previously infarcted human myocardium. J Cardiovasc Electrophysiol. 1999;10:336-342.
Badger TJ, Oakes RS, Daccarett M, et al. Temporal left atrial lesion formation after ablation of atrial fibrillation. Heart Rhythm. 2009;6:161-168.
Jaïs P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118:2498-2505.
Andrade JG, Khairy P, Verma A, et al. Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2012;35:106-112.
Kaitani K, Inoue K, Kobori A, et al. Efficacy of antiarrhythmic drugs short-term use after catheter ablation for atrial fibrillation (EAST-AF) trial. Eur Heart J. 2016;14:610-618.
Liang JJ, Dixit S. Early recurrences during the blanking period after atrial fibrillation ablation. J Atr Fibrillation. 2018;10:1726.
Bohne LJ, Johnson D, Rose RA, Wilton SB, Gillis AM. The association between diabetes mellitus and atrial fibrillation: clinical and mechanistic insights. Front Physiol. 2019;10:135.
Huang SK, Graham AR, Wharton K. Radiofrequency catheter ablation of the left and right ventricles: anatomic and electrophysiologic observations. Pacing Clin Electrophysiol. 1988;11:449-459.
Wittkamppf FH, Hauer RN, Robles de Medina EO. Control of radiofrequency lesion size by power regulation. Circulation. 1989;80:962-968.
Xue Y, Wang X, Thapa S, et al. Very early recurrence predicts long-term outcome in patients after atrial fibrillation catheter ablation: a prospective study. BMC Cardiovasc Disord. 2017;17:109.
Forkmann M, Schwab C, Edler D, et al. Characteristics of early recurrences detected by continuous cardiac monitoring influencing the long-term outcome after atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2019;30:1886-1893.
Malasana G, Day JD, Weiss JP, et al. A strategy of rapid cardioversion minimizes the significance of early recurrent atrial tachyarrhythmia after ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22:761-766.
Lellouche N, Jais P, Nault I, et al. Early recurrences after atrial fibrillation: prognostic value and effect of early reablation. J Cardiovasc Electrophysiol. 2008;19:599-605.