Incidence, characteristics, and prognostic significance of early recurrences after different ablation approaches for persistent atrial fibrillation

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dc.contributor.authorVirk, S.A.
dc.contributor.authorChieng, D.
dc.contributor.authorSegan, L.
dc.contributor.authorMorton, J.B.
dc.contributor.authorLee, G.
dc.contributor.authorSparks, P.
dc.contributor.authorMcLellan, A.J.
dc.contributor.authorSugumar, H.
dc.contributor.authorPrabhu, S.
dc.contributor.authorLing, L.H.
dc.contributor.authorVoskoboinik, A.
dc.contributor.authorPathak, R.K.
dc.contributor.authorSterns, L.D.
dc.contributor.authorGinks, M.
dc.contributor.authorSanders, P.
dc.contributor.authorKistler, P.
dc.contributor.authorKalman, J.
dc.date.issued2025
dc.descriptionOnlinePubl
dc.description.abstractBACKGROUND Early recurrence of atrial tachyarrhythmia (ERAT) is common after catheter ablation of atrial fibrillation (AF). The specific clinical and arrhythmia characteristics of ERAT influencing late recurrence risk in persistent AF are unclear. In addition, the impact of different ablation strategies on the incidence and prognostic significance of ERAT remains unknown. OBJECTIVE This study aimed to assess the incidence, characteristics, and prognostic impact of ERAT in patients with persistent AF undergoing pulmonary vein isolation alone or pulmonary vein isolation with posterior wall isolation. METHODS Trial participants monitored by implantable cardiac devices or twice-daily electrocardiogram transmissions were included. Atrial arrhythmia recurrences lasting ≥ 30 seconds were classified as ERAT (within 3 months after ablation) or late recurrence (between 3 and 12 months). RESULTS Of the 282 included patients, ERAT occurred in 124 (44.0%). ERAT portended an increased incidence of late recurrence (68.5% vs 32.9%; hazard ratio, 3.36; 95% confidence interval, 2.35–4.79) and significantly higher post–blanking period AF burden (median, 0.66% [interquartile range, 0–8.35%] vs 0% [0–0.55%]). The hazard ratio for late recurrence was 2.34 (1.48–3.71), 2.89 (1.63–5.12), and 6.00 (3.86–9.32) when the latest ERAT occurred in the first, second, and third month, respectively. Late recurrence risk was particularly elevated in patients with high-burden, frequent, or symptomatic ERAT. Ablation strategy did not affect the incidence, burden, arrhythmia characteristics, or prognostic significance of ERAT. CONCLUSION ERAT after radiofrequency ablation of persistent AF is an independent predictor of late recurrence and increased post–blanking period AF burden. An individualized assessment of early recurrences is warranted to critically evaluate their clinical significance.
dc.description.statementofresponsibilitySohaib A. Virk, David Chieng, Louise Segan, Joseph B. Morton, Geoffrey Lee, Paul Sparks, Alex J. McLellan, Hariharan Sugumar, Sandeep Prabhu, Liang-Han Ling, Aleksandr Voskoboinik, Rajeev K. Pathak, Laurence D. Sterns, Matthew Ginks, Prashanthan Sanders, Peter Kistler, Jonathan Kalman
dc.identifier.citationHeart Rhythm, 2025; 1-10
dc.identifier.doi10.1016/j.hrthm.2024.12.031
dc.identifier.issn1547-5271
dc.identifier.issn1556-3871
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttps://hdl.handle.net/2440/144472
dc.language.isoen
dc.publisherElsevier
dc.relation.grantNHMRC
dc.rights© 2024 Heart Rhythm Society. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
dc.source.urihttps://doi.org/10.1016/j.hrthm.2024.12.031
dc.subjectAtrial fibrillation
dc.subjectBlanking period
dc.subjectCatheter ablation
dc.subjectPosterior wall isolation
dc.subjectPulmonary vein isolation
dc.titleIncidence, characteristics, and prognostic significance of early recurrences after different ablation approaches for persistent atrial fibrillation
dc.typeJournal article
pubs.publication-statusPublished

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