Predictors of Very Late Recurrence of Atrial Fibrillation After Circumferential Pulmonary Vein Ablation

Ma, Changsheng; Liu, Xingpeng; Dong, Jianzeng; Tang, Ri‐Bo; Kang, Jia; Yu, Rong‐Hui; Tian, Ying

doi:10.1002/clc.20340

Cited by 23 publications

(12 citation statements)

References 20 publications

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“…Some of the MB-LATER score components, such as AF clinical type, LA dilatation and ERAF have been already recognized as independent predictors of AF recurrence following ablation and were incorporated in other scoring systems71011121718. In our study, BBB was significantly associated with VLRAF.…”

Section: Discussionmentioning

confidence: 54%

“…Numerous clinical variables were identified as independent predictors of VLRAF: non-paroxysmal AF, aging, LV systolic and diastolic dysfunction, high preoperative C-reactive protein level, LA enlargement, higher CHADS 2 score, the presence of non-PV triggers, obesity, hypertension, hyperlipidaemia and ERAF4571718252627. It’s possible that these risk factors continue to affect the process of atrial remodelling despite initially “successful” ablation, leading to the substrate and triggers evolution over years, and the „very late“ reappearance of AF.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Mujović

Marinković

Marković

et al. 2017

Sci Rep

105

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Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), Catheter-ablation (CA) is superior to antiarrhythmic drugs (AADs) in patients with symptomatic atrial fibrillation (AF), but AF may re-occur despite multiple re-do procedures and recent technical improvements 1,2 . Most arrhythmia recurrences are identified within the first year after the procedure, while further long-term follow-up strategy for initially "successfully" treated patients is less well defined and inconsistently reported 1-9 .Several studies described a progressive increase in the arrhythmia recurrence rates over time in patients with initial post-ablation suppression of AF 4-6 . It is reported that 10-40% of patients who were arrhythmia free within the first post-procedural year experienced very late recurrence of AF (VLRAF) over long-term follow-up 2-9 . Several scoring systems (i.e., the APPLE, ALARMc and BASE-AF2 score) were recently proposed to predict the short-term risk of AF recurrence after the procedure 10-12 . However, none of these scores have addressed VLRAF occurring in patients who were free of AF at 1 year post procedure. Importantly, reliable identification of increased risk of VLRAF could strongly influence decision-making regarding the long-term use of oral anticoagulation and/or AAD therapy as well as the long-term monitoring strategy after the procedure 1,2 . Due to altered risk/benefit ratio, multiple AF ablation procedures may not be justified in patients at high risk of recurrent AF, and reliable prediction of VLRAF could optimize the patient selection for re-do CA 1,2,9,11 .

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Mujović

Marinković

Marković

et al. 2017

Sci Rep

105

View full text Add to dashboard Cite

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“…11 A relatively uniform finding among studies that have reported more than 1 year of follow-up is that presence of persistent AF at baseline may adversely affect overall outcomes for PVI. 3,[13][14][15][16] Clues to the underlying AF substrate are suggested by the larger left atrial size and higher number of AF triggers in our study, both of which may be surrogates for the extent of left atrial remodeling. Also important to recognize is that the majority of patients in the present study who underwent redo procedures continue to do very well, with a majority of them continuing to remain free of AF off AAD.…”

Section: Tzou Et Al Long-term Af Ablation Follow-up 239mentioning

confidence: 91%

“…A study of 249 patients, with paroxysmal and persistent AF undergoing a first PVI, was recently reported from Ma et al 15 Very late AF recurrence, defined as Ͼ12 months after first PVI, occurred in 32% of patients after an average of 18 months after the procedure. Similar to our findings, presence of persistent AF predicted very late recurrence.…”

Section: Tzou Et Al Long-term Af Ablation Follow-up 239mentioning

confidence: 99%

“…The results are consistent with other reports that have documented PV reconnection and PV triggers in patients with AF recurrence after 1 year. 3,8,11,12,14,15,22,23 There are increasing data in the literature that asymptomatic AF is not uncommon after PV isolation. 24,25 It is possible Figure. A, Long-term AF freedom in patients with no recurrent AF for 1 year after AF ablation without use of AADs.…”

Section: Tzou Et Al Long-term Af Ablation Follow-up 239mentioning

confidence: 99%

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Long-Term Outcome After Successful Catheter Ablation of Atrial Fibrillation

Tzou

Marchlinski

Zado

et al. 2010

Circ: Arrhythmia and Electrophysiology

202

122

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Background-Pulmonary vein isolation (PVI) is increasingly used for treatment of atrial fibrillation (AF), but few reports exist regarding long-term success. We determined 5-year outcomes of PVI among patients with freedom from AF off antiarrhythmic drugs (AAD) for 1 year after PVI. Methods and Results-Consecutive patients with paroxysmal or persistent AF who underwent PVI at the University of Pennsylvania from 2000 to 2003 and were free from AF 1 year after ablation were included. Proximal isolation of PVs and non-PV triggers of AF was performed. Long-term ablation success, defined as freedom from AF off AAD after a single ablation procedure, was determined. All patients had transtelephonic monitoring at 3 to 6 months and 12 months and at least yearly contact thereafter. One hundred twenty-three patients were free of AF without AAD at 1 year. AF freedom off AAD was 85% at 3 years and 71% at 5 years, with an approximate 7% per year late recurrence rate after the first year. Patients with recurrent AF Ն5 years after index PVI were older, had larger left atrial size, more AF triggers and more likely had persistent AF. In multivariate analysis, persistent AF (odds ratio, 2.8; 95% confidence interval, 1.4 to 5.7, Pϭ0.005) and age (odds ratio, 1.1; 95% confidence interval, 1.0 to 1.1, Pϭ0.036) independently predicted long-term AF recurrence. Conclusions-Among patients with paroxysmal or persistent AF and AF freedom 1 year after segmental PVI, the majority (71%) remained free of AF for up to 5 years, with an approximate late recurrence rate of 7% per year. Continued vigilance for recurrent AF after PV isolation is warranted, particularly in patients with persistent AF. (Circ Arrhythm Electrophysiol. 2010;3:237-242.)

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Association Between C‐Reactive Protein and Atrial Fibrillation Recurrence After Catheter Ablation: A Meta‐analysis

Jiang

Dai

Zhang

et al. 2013

Clinical Cardiology

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Background: Atrial fibrillation (AF) is associated with inflammation. Increased serum C-reactive protein (CRP) levels are important representatives of an inflammatory state of AF. A variety of studies have evaluated whether increased CRP levels have an association with AF recurrence after catheter ablation. However, the results remain inconsistent, therefore, this meta-analysis was conducted to offer suggestions. Hypothesis: Increased baseline CRP have an association with AF recurrence after catheter ablation. Methods: Electronic databases including PubMed, Embase, Medline, ISI Web of Knowledge, and ScienceDirect were searched until December 31, 2012 for any CRP-associated studies. Overall and subgroup analyses were performed. Standardized mean difference (SMD) and 95% confidence interval (CI) were used to evaluate the associations between CRP levels and postablation AF recurrence. Statistical analysis was performed with Review Manager 5.2 and Stata 11.0. Results: Seven available studies were identified, which included 526 patients (179 recurrence vs 347 no recurrence). Overall, increased baseline CRP levels had significant positive association with postablation AF recurrence. The SMD in the CRP levels was 0.65 units (95% CI: 0.30-0.99), and the z-score for overall effect was 3.70 (P = 0.0002). The heterogeneity test showed that there were moderate differences between individual studies (P = 0.006, I 2 = 67%). Metaregression revealed that different sample sizes of studies possibly accounted for the heterogeneity. Positive associations were also found in subgroup analyses based on sample size. When stratifying for ethnicity, similarly significant associations were found in both European (Caucasian) and Asian populations. Conclusions: Investigations demonstrate that baseline CRP levels are greater in patients with postablation AF recurrence. Further studies with larger sample size and delicate design for CRP should be conducted. IntroductionAtrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, and approximately onethird of all cardiac arrhythmia-related hospitalizations are due to AF.

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Predictors of Very Late Recurrence of Atrial Fibrillation After Circumferential Pulmonary Vein Ablation

Cited by 23 publications

References 20 publications

Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Long-Term Outcome After Successful Catheter Ablation of Atrial Fibrillation

Association Between C‐Reactive Protein and Atrial Fibrillation Recurrence After Catheter Ablation: A Meta‐analysis

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