Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods

Abstract

Background and objectives: Pulmonary vein (PV) reconnection is a major reason for recurrence after catheter ablation of paroxysmal atrial fibrillation (PAF). However, the timing of the recurrence varies between patients, and recurrence >1 year after ablation is not uncommon. We sought to elucidate the characteristics of atrial fibrillation (AF) that recurred in different follow-up periods. Materials and Methods: Study subjects comprised 151 consecutive patients undergoing initial catheter ablation of PAF. Left atrial volume index (LAVi) and atrial/brain natriuretic peptide (ANP/BNP) levels were systematically measured annually over 3 years until AF recurred. Results: Study subjects were classified into four groups: non-recurrence group (n = 84), and short-term- (within 1 year) (n = 30), mid-term- (1–3 years) (n = 26), and long-term-recurrence group (>3 years) (n = 11). The short-term-recurrence group was characterized by a higher prevalence of diabetes mellitus (hazard ratio 2.639 (95% confidence interval, 1.174–5.932), p = 0.019 by the Cox method), frequent AF episodes (≥1/week) before ablation (4.038 (1.545–10.557), p = 0.004), and higher BNP level at baseline (per 10 pg/mL) (1.054 (1.029–1.081), p < 0.0001). The mid-term-recurrence group was associated with higher BNP level (1.163 (1.070–1.265), p = 0.0004), larger LAVi (mL/m2) (1.033 (1.007–1.060), p = 0.013), and longer AF cycle length at baseline (per 10 ms) (1.194 (1.058–1.348), p = 0.004). In the long-term-recurrence group, the ANP and BNP levels were low throughout follow-up, as with those in the non-recurrence group, and AF cycle length was shorter (0.694 (0.522–0.924), p = 0.012) than those in the other recurrence groups. Conclusions: Distinct characteristics of AF were found according to the time to first recurrence after PAF ablation. The presence of secondary factors beyond PV reconnections could be considered as mechanisms for the recurrence of PAF in each follow-up period.

Long-term outcomes of radiofrequency catheter ablation for patients with persistent atrial fibrillation lasting ≥ 3 years

“…The concept of “AF begets AF” underscores the challenge of managing prolonged AF states [18]. Current research has demonstrated a significant correlation between pre-procedure AF duration and post-RFCA recurrence rates [19, 20]. One study has indicated that longer AF duration significantly increases the recurrence rate, especially among patients with persistent AF lasting over three years [10].…”

Association of Preablation Plasma Corin Levels With Atrial Fibrillation Recurrence After Catheter Ablation: A Prospective Observational Study

“…Third, some clinical studies have found that elevated ANP, or midregional N‐terminal pro‐ANP, type B natriuretic peptide, and N‐terminal pro‐BNP levels were significantly associated with the risk factor of AF recurrence after ablation. 54 , 55 , 56 , 57 , 58 We did not discuss the association between those factors and recurrent AF after ablation. Fourth, plasma corin levels are correlated with immediate heart rhythm, as confirmed by higher concentrations in AF than in sinus rhythm.…”

Deep Learning-based Handheld Device-Enabled Symptom-driven Recording: A Pragmatic Approach for the Detection of Post-ablation Atrial Fibrillation Recurrence

“…The basic post-ablation monitoring strategy recommended by the HRS/EHRA/ECAS expert consensus statement [2] includes a 12-lead electrocardiogram (ECG) at a minimum of three visits (at 3, 6, and 12 months) and 24-hour Holter monitoring at the end of the follow-up period (12 months). In addition to the scheduled ECG recording, timely medical contact whenever symptoms occur is recommended for the detection of symptomatic episodes [3][4][5]. However, symptoms may resolve before…”