Clinical impact of very early recurrence of atrial fibrillation after radiofrequency catheter ablation

Published:August 20, 2021DOI:https://doi.org/10.1016/j.jjcc.2021.08.004

      Highlights

      • We investigated the significance of very early recurrence of atrial fibrillation (VERAF) after radiofrequency catheter ablation.
      • Patients with VERAF had a low incidence of late recurrence of AF.
      • Patients with VERAF had a low incidence of pulmonary vein reconnections.

      Abstract

      Background

      Little has been reported on the impact of very early recurrence of atrial fibrillation (VERAF) after radiofrequency catheter ablation (RFCA).

      Methods

      We enrolled 201 consecutive patients who underwent an initial RFCA of atrial fibrillation (AF) between September 2014 and April 2019 in our hospital and experienced early recurrence of AF (ERAF, defined as recurrence of atrial tachyarrhythmia within 3 months after RFCA). These patients were categorized into three groups: Group A who experienced recurrence of atrial tachyarrhythmia only within 48 h after RFCA, Group B who experienced recurrence of atrial tachyarrhythmia both within 48 h and between 48 h and 3 months after RFCA, and Group C who experienced the first recurrence of atrial tachyarrhythmia between 48 h and 3 months after RFCA. We compared the patient characteristics, ablation procedure and procedure-related complications, and clinical outcomes among the three groups. In addition, we investigated the pulmonary vein (PV) reconnections in the patients who experienced a repeat ablation procedure due to late recurrence of AF (LRAF, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after RFCA).

      Results

      The Group A, B, and C consisted of 54, 40, and 107 patients, respectively. The inflammatory markers on the second day of RFCA were significantly higher in Group A. Moreover, Group A had a lower incidence of LRAF (p < 0.001) and PV reconnections at repeat ablation procedure (p = 0.023).

      Conclusions

      VERAF may have better clinical outcomes including lower incidence of LRAF and PV reconnections among patients with ERAF.

      Graphical Abstract

      Keywords

      To read this article in full you will need to make a payment
      Subscribe to Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Odutayo A.
        • Wong C.X.
        • Hsiao A.J.
        • Hopewell S.
        • Altman D.G.
        • Emdin C.A.
        Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis.
        BMJ. 2016; 354: i4482
        • Friberg L.
        • Hammar N.
        • Pettersson H.
        • Rosenqvist M.
        Increased mortality in paroxysmal atrial fibrillation: report from the Stockholm Cohort-Study of Atrial Fibrillation (SCAF).
        Eur Heart J. 2007; 28: 2346-2353
        • Andersson T.
        • Magnuson A.
        • Bryngelsson I.L.
        • Frøbert O.
        • Henriksson K.M.
        • Edvardsson N.
        • et al.
        All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study.
        Eur Heart J. 2013; 34: 1061-1067
        • Calkins H.
        • Hindricks G.
        • Cappato R.
        • Kim Y.H.
        • Saad E.B.
        • Aguinaga L.
        • et al.
        2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation.
        Heart Rhythm. 2017; 14: e275-e444
        • Latchamsetty R.
        • Morady F.
        Long-term benefits following catheter ablation of atrial fibrillation.
        Circ J. 2013; 77: 1091-1096
        • Hori Y.
        • Nakahara S.
        • Fukuda R.
        • Sato H.
        • Ukaji T.
        • Koshikawa Y.
        • et al.
        Atrial reverse remodeling represented by the atrial conduction time in persistent atrial fibrillation patients after catheter ablation: its impact on predicting late atrial fibrillation recurrence.
        J Cardiol. 2020; 75: 521-528
        • Okawa K.
        • Miyoshi T.
        • Sogo M.
        • Hara S.
        • Sudo Y.
        • Ugawa S.
        • et al.
        Improvement in renal and endothelial function after catheter ablation in patients with persistent atrial fibrillation.
        J Cardiol. 2020; 76: 610-617
        • Oral H.
        • Knight B.P.
        • Ozaydin M.
        • Tada H.
        • Chugh A.
        • Hassan S.
        • et al.
        Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation.
        J Am Coll Cardiol. 2002; 40: 100-104
        • Lellouche N.
        • Jaïs P.
        • Nault I.
        • Wright M.
        • Bevilacqua M.
        • Knecht S.
        • et al.
        Early recurrences after atrial fibrillation ablation: prognostic value and effect of early reablation.
        J Cardiovasc Electrophysiol. 2008; 19: 599-605
        • Andrade J.G.
        • Khairy P.
        • Verma A.
        • Guerra P.G.
        • Dubuc M.
        • Rivard L.
        • et al.
        Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation.
        Pacing Clin Electrophysiol. 2012; 35: 106-116
        • O'Donnell D.
        • Furniss S.S.
        • Dunuwille A.
        • Bourke J.P.
        Delayed cure despite early recurrence after pulmonary vein isolation for atrial fibrillation.
        Am J Cardiol. 2003; 91: 83-85
        • Andrade J.G.
        • Khairy P.
        • Macle L.
        • Packer D.L.
        • Lehmann J.W.
        • Holcomb R.G.
        • et al.
        Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial.
        Circ Arrhythm Electrophysiol. 2014; 7: 69-75
        • Nalliah C.J.
        • Lim T.W.
        • Kizana E.
        • Qian P.
        • Kovoor P.
        • Thiagalingam A.
        • et al.
        Clinical significance of early atrial arrhythmia type and timing after single ring isolation of the pulmonary veins.
        Europace. 2015; 17: 1038-1044
        • Mugnai G.
        • de Asmundis C.
        • Hünük B.
        • Ströker E.
        • Velagic V.
        • Moran D.
        • et al.
        Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: Predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences.
        Heart Rhythm. 2016; 13: 845-851
        • Koyama T.
        • Sekiguchi Y.
        • Tada H.
        • Arimoto T.
        • Yamasaki H.
        • Kuroki K.
        • et al.
        Comparison of characteristics and significance of immediate versus early versus no recurrence of atrial fibrillation after catheter ablation.
        Am J Cardiol. 2009; 103: 1249-1254
        • Chang S.L.
        • Tsao H.M.
        • Lin Y.J.
        • Lo L.W.
        • Hu Y.F.
        • Tuan T.C.
        • et al.
        Characteristics and significance of very early recurrence of atrial fibrillation after catheter ablation.
        J Cardiovasc Electrophysiol. 2011; 22: 1193-1198
        • Yano M.
        • Egami Y.
        • Yanagawa K.
        • Nakamura H.
        • Matsuhiro Y.
        • Yasumoto K.
        • et al.
        Comparison of myocardial injury and inflammation after pulmonary vein isolation for paroxysmal atrial fibrillation between radiofrequency catheter ablation and cryoballoon ablation.
        J Cardiovasc Electrophysiol. 2020; 31: 1315-1322
        • Lim H.S.
        • Schultz C.
        • Dang J.
        • Alasady M.
        • Lau D.H.
        • Brooks A.G.
        • et al.
        Time course of inflammation, myocardial injury, and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation.
        Circ Arrhythm Electrophysiol. 2014; 7: 83-89
        • Kourliouros A.
        • Camm A.J.
        Does inflammation influence atrial fibrillation recurrence following catheter ablation?.
        Europace. 2009; 11: 135-137
        • Kim Y.G.
        • Boo K.Y.
        • Choi J.I.
        • Choi Y.Y.
        • Choi H.Y.
        • Roh S.Y.
        • et al.
        Early recurrence is reliable predictor of late recurrence after radiofrequency catheter ablation of atrial fibrillation.
        JACC Clin Electrophysiol. 2021; 7: 343-351