Predictors of recurrence of atrial fibrillation within the first 3months after ablation

Matthias D Zink; Winnie Wei Ling Chua; Stef Zeemering; Luigi  Di Biase; Bayes de  Luna Antoni; David Callans; Gerhard Hindricks; Karl Georg Haeusler; Hussein R. Al-Khalidi; Jonathan  Piccini; Lluis Mont; Jens Cosedis Nielsen; Luis Alberto Escobar; Joseph De Bono; Isabelle C Van Gelder; Tom De Potter; Daniel Scherr; Themistoclakis Sakis; Derick Todd; Paulus Kirchhof; Ulrich Schotten

doi:10.1093/europace/euaa132

Predictors of recurrence of atrial fibrillation within the first 3months after ablation

Matthias D Zink, Winnie Wei Ling Chua, Stef Zeemering, Luigi Di Biase, Bayes de Luna Antoni, David Callans, Gerhard Hindricks, Karl Georg Haeusler, Hussein R. Al-Khalidi, Jonathan Piccini, Lluis Mont, Jens Cosedis Nielsen, Luis Alberto Escobar, Joseph De Bono, Isabelle C Van Gelder, Tom De Potter, Daniel Scherr, Themistoclakis Sakis, Derick Todd, Paulus KirchhofUlrich Schotten

Cardiovascular Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

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 results
We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the 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.

Trial registration
Clinicaltrials.gov identifier NCT02227550

Original language	English
Pages (from-to)	1337-1344
Journal	European Society of Cardiology
Volume	22
Issue number	9
DOIs	https://doi.org/10.1093/europace/euaa132
Publication status	Published - 28 Jul 2020

Keywords

AXAFA
Ablation
Apixaban
Atrial fibrillation
Blanking period
Early recurrence

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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Zink, M. D., Chua, W. W. L., Zeemering, S., Di Biase, L., Luna Antoni, B. D., Callans, D., Hindricks, G., Haeusler, K. G., Al-Khalidi, H. R., Piccini, J., Mont, L., Nielsen, J. C., Escobar, L. A., De Bono, J., Van Gelder, I. C., De Potter, T., Scherr, D., Sakis, T., Todd, D., ... Schotten, U. (2020). Predictors of recurrence of atrial fibrillation within the first 3months after ablation. European Society of Cardiology, 22(9), 1337-1344. https://doi.org/10.1093/europace/euaa132

@article{f6a6b02ec8224a3f8e084acdebb3d892,

title = "Predictors of recurrence of atrial fibrillation within the first 3months after ablation",

abstract = "AimsFreedom 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 resultsWe retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the 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).ConclusionHalf 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.Trial registrationClinicaltrials.gov identifier NCT02227550",

keywords = "AXAFA, Ablation, Apixaban, Atrial fibrillation, Blanking period, Early recurrence",

author = "Zink, {Matthias D} and Chua, {Winnie Wei Ling} and Stef Zeemering and {Di Biase}, Luigi and {Luna Antoni}, {Bayes de} and David Callans and Gerhard Hindricks and Haeusler, {Karl Georg} and Al-Khalidi, {Hussein R.} and Jonathan Piccini and Lluis Mont and Nielsen, {Jens Cosedis} and Escobar, {Luis Alberto} and {De Bono}, Joseph and {Van Gelder}, {Isabelle C} and {De Potter}, Tom and Daniel Scherr and Themistoclakis Sakis and Derick Todd and Paulus Kirchhof and Ulrich Schotten",

year = "2020",

month = jul,

day = "28",

doi = "10.1093/europace/euaa132",

language = "English",

volume = "22",

pages = "1337--1344",

journal = "European Society of Cardiology",

number = "9",

}

Zink, MD, Chua, WWL, Zeemering, S, Di Biase, L, Luna Antoni, BD, Callans, D, Hindricks, G, Haeusler, KG, Al-Khalidi, HR, Piccini, J, Mont, L, Nielsen, JC, Escobar, LA, De Bono, J, Van Gelder, IC, De Potter, T, Scherr, D, Sakis, T, Todd, D, Kirchhof, P & Schotten, U 2020, 'Predictors of recurrence of atrial fibrillation within the first 3months after ablation', European Society of Cardiology, vol. 22, no. 9, pp. 1337-1344. https://doi.org/10.1093/europace/euaa132

TY - JOUR

T1 - Predictors of recurrence of atrial fibrillation within the first 3months after ablation

AU - Zink, Matthias D

AU - Chua, Winnie Wei Ling

AU - Zeemering, Stef

AU - Di Biase, Luigi

AU - Luna Antoni, Bayes de

AU - Callans, David

AU - Hindricks, Gerhard

AU - Haeusler, Karl Georg

AU - Al-Khalidi, Hussein R.

AU - Piccini, Jonathan

AU - Mont, Lluis

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 - Sakis, Themistoclakis

AU - Todd, Derick

AU - Kirchhof, Paulus

AU - Schotten, Ulrich

PY - 2020/7/28

Y1 - 2020/7/28

N2 - AimsFreedom 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 resultsWe retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the 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).ConclusionHalf 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.Trial registrationClinicaltrials.gov identifier NCT02227550

AB - AimsFreedom 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 resultsWe retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the 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).ConclusionHalf 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.Trial registrationClinicaltrials.gov identifier NCT02227550

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

U2 - 10.1093/europace/euaa132

DO - 10.1093/europace/euaa132

M3 - Article

VL - 22

SP - 1337

EP - 1344

JO - European Society of Cardiology

JF - European Society of Cardiology

IS - 9

ER -

Predictors of recurrence of atrial fibrillation within the first 3months after ablation

Abstract

Keywords

ASJC Scopus subject areas

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