TY - JOUR
T1 - Predictors of recurrence of atrial fibrillation within the first 3 months after ablation
AU - Zink, Matthias Daniel
AU - Chua, Winnie
AU - Zeemering, Stef
AU - di Biase, Luigi
AU - de Luna Antoni, Bayes
AU - David, Callans
AU - Hindricks, Gerhard
AU - Haeusler, Karl Georg
AU - Al-Khalidi, Hussein R.
AU - Piccini, Jonathan P.
AU - Mont, Lluís
AU - Nielsen, Jens Cosedis
AU - Escobar, Luis Alberto
AU - de Bono, Joseph
AU - van Gelder, Isabelle C.
AU - de Potter, Tom
AU - Scherr, Daniel
AU - Themistoclakis, Sakis
AU - Todd, Derick
AU - Kirchhof, Paulus
AU - Schotten, Ulrich
N1 - Funding Information:
AXAFA-AFNET 5 is an investigator-initiated trial. Sponsor of the trial is AFNET. AXAFA-AFNET 5 was partially funded by BMS/Pfizer, the DZHK (German Centre for Cardiovascular Research), and by the BMBF (German Ministry of Education and Research) to AFNET. Furthermore, this work was supported by the European Union (CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly, No. 633196, the ITN Network AFibTrainNet, No. 675351, and the ERACoSysMED H2020 ERA-NET Cofund project Systems medicine for diagnosis and stratification of atrial fibrillation), British Heart Foundation (FS/13/43/30324 to P.K.), Leducq Foundation to P.K., and the Netherlands Heart Foundation (RACE V) to U.S. and I.v.G. AFNET, DZHK, BMS/Pfizer; AXAFA-AFNET 5; NCT02227550.
Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Aims Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50-70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. Methods and We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the results randomized controlled AXAFA-AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93-2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20-2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26-2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00-1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). Conclusion Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF.
AB - Aims Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50-70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. Methods and We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the results randomized controlled AXAFA-AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93-2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20-2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26-2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00-1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). Conclusion Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF.
KW - AXAFA
KW - Ablation
KW - Apixaban
KW - Atrial fibrillation
KW - Blanking period
KW - Early recurrence
UR - http://www.scopus.com/inward/record.url?scp=85091325022&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091325022&partnerID=8YFLogxK
U2 - 10.1093/europace/euaa132
DO - 10.1093/europace/euaa132
M3 - Article
C2 - 32725107
AN - SCOPUS:85091325022
SN - 1099-5129
VL - 22
SP - 1337
EP - 1344
JO - Europace
JF - Europace
IS - 9
ER -