Clinical significance of the timing of early recurrence of atrial arrhythmia after pulmonary vein isolation: a two-institution clinical study

• Published in: Heart and vessels Vol. 34; no. 5; pp. 842 - 850
• Main Authors: Murase, Yosuke, Inden, Yasuya, Imai, Hajime, Kyo, Seifuku, Yanagisawa, Satoshi, Fujii, Aya, Sakamoto, Yusuke, Tomomatsu, Toshiro, Murohara, Toyoaki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-05-2019; Springer Nature B.V
• Subjects: Ablation; Arrhythmia; Biomedical Engineering and Bioengineering; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Clinical significance; Confidence intervals; Fibrillation; Medicine; Medicine & Public Health; Multivariate analysis; Original Article; Patients; Vascular Surgery; Early recurrence; Atrial arrhythmia recurrence; Left atrial diameter; Paroxysmal atrial fibrillation; Catheter ablation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-018-1295-1

Early recurrence of atrial arrhythmia (ERAA) after ablation frequently occurs, but there is limited evidence about ERAA-timing. This study aimed to investigate the association between ERAA-timing and late recurrence. We retrospectively investigated 332 patients who underwent PVI for paroxysmal atrial fibrillation at Nagoya University Hospital and Komaki City Hospital. Seventy-six patients (23%) had ERAA. The cutoff value of the first ERAA for late recurrence was set as 3 days, with a specificity of 77% and sensitivity of 43%. On multivariate analysis, first ERAA beyond 3 days (hazard ratio, 2.477; 95% confidence interval, 1.168–5.25;
p
 = 0.018) and large left atrial diameter (LAD) (hazard ratio, 1.101; 95% confidence interval, 1.024–1.184;
p
 = 0.009) were independent predictors for late recurrence. Patients who had first ERAA within 3 days and no ERAA beyond 3 days showed a significantly higher recurrence–free rate than those who had first ERAA beyond 3 days and those who had ERAA both within 3 days and beyond 3 days (89% versus 39%, 44%;
p 
 < 0.001). Moreover, the patients with ERAA within 3 days and LAD ≤ 37.7 mm showed a significantly higher recurrence–free rate than those with ERAA beyond 3 days and LAD > 37.7 mm, and as compared with the other patients (100% versus 26% and 60%, respectively;
p
 < 0.001). ERAA beyond 3 days after ablation was a predictor for late recurrence. Among patients with ERAA, those with ERAA within 3 days and smaller LAD showed favorable prognosis after ablation.