Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation

• Published in: Journal of cardiovascular electrophysiology Vol. 34; no. 12; pp. 2504 - 2513
• Main Authors: Li, Guan‐Yi, Elimam, Ahmed Moustafa, Lo, Li‐Wei, Lin, Yenn‐Jiang, Chang, Shih‐Lin, Hu, Yu‐Feng, Chung, Fa‐Po, Chao, Tze‐Fan, Lin, Chin‐Yu, Liu, Chih‐Min, Liao, Jo‐Nan, Ton, An Khanh‐ Nu, Yugo, Dony, Lin, Linda, Tuan, Ta‐Chuan, Kao, Pei Heng, Liu, Shin‐Huei, Chhay, Chheng, Kuo, Ling, Cheng, Wen‐Han, Chen, Wei‐Tso, Chen, Shih‐Ann
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2023
• Subjects: Ablation; Aged; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Cardiac arrhythmia; catheter ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheters; Fibrillation; Humans; left atrium; Male; Middle Aged; non‐pulmonary vein trigger; progression; Provocation tests; Pulmonary Veins - surgery; Radiofrequency ablation; Recurrence; thyroid; Thyroid Diseases; Treatment Outcome; recurrence; atrial fibrillation; non-pulmonary vein trigger; thyroid; progression; catheter ablation; left atrium
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16100

Introduction Despite undergoing an index ablation, some patients progress from paroxysmal atrial fibrillation (PAF) to persistent AF (PersAF), and the mechanism behind this is unclear. The aim of this study was to investigate the predictors of progression to PersAF after catheter ablation in patients with PAF. Methods This study included 400 PAF patients who underwent an index ablation between 2015 and 2019. The patients were classified into three groups based on their outcomes: Group 1 (PAF to sinus rhythm, n = 226), Group 2 (PAF to PAF, n = 146), and Group 3 (PAF to PersAF, n = 28). Baseline and procedural characteristics were collected, and predictors for AF recurrence and progression were evaluated. Results The mean age of the patients was 58.4 ± 11.1 years, with 272 males. After 3 years of follow‐up, 7% of the PAF cases recurred and progressed to PersAF despite undergoing an index catheter ablation. In the multivariable analysis, a larger left atrial (LA) diameter and the presence of non‐pulmonary vein (PV) triggers during the index procedure independently predicted recurrence. Moreover, a larger LA diameter, the presence of non‐PV triggers, and a history of thyroid disease independently predicted AF progression. Conclusion The progression from PAF to PersAF after catheter ablation is associated with a larger LA diameter, history of thyroid disease, and the presence of non‐PV triggers. Meticulous preprocedural evaluation, patient selection, and comprehensive provocation tests during catheter ablation are recommended. The study investigated the outcomes of 400 patients with PAF who underwent an index ablation procedure, while also identifying the predictors associated with recurrence and progression to PersAF. CI, confidence interval; OR, odd ratio; PAF, paroxysmal atrial fibrillation; PersAF, persistent atrial fibrillation; SR, sinus rhythm.