Persistent Atrial Fibrillation Phenotypes and Ablation Outcomes: Persistent From Outset vs Progression From Paroxysmal AF.

BACKGROUND

Many patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation.

OBJECTIVES

This study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation.

METHODS

CAPLA (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]) was a multicenter trial that randomized patients with PsAF to PVI plus PWI or PVI alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period.

RESULTS

A total of 334 patients were included (median age 65.6 years, 23.1% female), 194 (58.1%) had PsAF at first AF diagnosis and 140 (41.9%) had PAF. Patients with PsAF at diagnosis were younger (age 64.0 vs 67.7 years, P = 0.005), had higher rates of heart failure (P < 0.001), and lower left ventricular ejection fraction (54.5% IQR: 40-60 vs 60% IQR: 50-61, P = 0.007). AF recurrence occurred in 85 (43.8%) with PsAF at diagnosis and 70 (50%) with PAF at diagnosis. PsAF at diagnosis was not associated with risk of recurrence on univariable (HR: 0.802; 95% CI: 0.585-1.101; P = 0.173) or multivariable analysis (HR: 0.922; 95% CI: 0.647-1.312; P = 0.650). Median AF burden was 0% in both groups (P = 0.125). There was no difference in left atrial size (P = 0.337) or bipolar voltage (P = 0.579) between the groups.

CONCLUSIONS

In the CAPLA cohort of patients, pattern of AF at first diagnosis did not influence post-ablation rate of AF recurrence or AF burden. (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]; ACTRN12616001436460).

Informations de copyright

Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Kalman is a recipient of a National Health and Medical Research Council (NHMRC) Clinical Investigator Grant; and has received research and fellowship support from Medtronic, Abbott, Zoll, and Biosense Webster. Dr Kistler is a recipient of a Clinical Investigator grant from the NHMRC; has received funding from Abbott Medical for consultancy and speaking engagements; and has served on the advisory board with fellowship support from Biosense Webster. Dr Sanders has served on advisory boards for Medtronic, Abbott Medical, CathRx, Pacemate, and Boston Scientific; and has been supported by a practitioner fellowship from NHMRC and the National Heart Foundation of Australia (NHF). Dr Lee has received consulting fees from Biosense Webster. Dr Prabhu is supported by an NHMRC Post-Doctoral Research Fellowship; and has received consulting fees, fellowship support, and educational grants from Biosense Webster, Abbott Medical, and Boston Scientific. Dr Ling has received grants from Abbott Australia. Dr Chieng is supported by an NHF Post-Doctoral Fellowship. Dr Crowley is supported by a Baker institute PhD scholarship. Dr William is supported by an NHF postgraduate PhD scholarship. Dr Segan is support by a co-funded NHMRC/NHF postgraduate PhD scholarship. Dr Sterns has received personal fees from Biosense Webster. Dr Ginks has served on Speakers Bureau for Biosense Webster Speaker and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.