Time to cardioversion of recurrent atrial arrhythmias after catheter ablation of atrial fibrillation and long-term clinical outcome.
BACKGROUND
It is unclear whether early restoration of sinus rhythm in patients with persistent atrial arrhythmias after catheter ablation of atrial fibrillation (AF) facilitates reverse atrial remodeling and promotes long-term maintenance of sinus rhythm. The purpose of this study was to determine the relationship between the time to restoration of sinus rhythm after a recurrence of an atrial arrhythmia and long-term maintenance of sinus rhythm after radiofrequency catheter ablation of AF.


RESULTS
Radiofrequency catheter ablation was performed in 384 consecutive patients (age 60 +/- 9 years) for paroxysmal (215 patients) or persistent AF (169 patients). Transthoracic cardioversion was performed in all 93 patients (24%) who presented with a persistent atrial arrhythmia: AF (n = 74) or atrial flutter (n = 19) at a mean of 51 +/- 53 days from the recurrence of atrial arrhythmia and 88 +/- 72 days from the ablation procedure. At a mean of 16 +/- 10 months after the ablation procedure, 25 of 93 patients (27%) who underwent cardioversion were in sinus rhythm without antiarrhythmic therapy. Among the 46 patients who underwent cardioversion at < or =30 days after the recurrence, 23 (50%) were in sinus rhythm without antiarrhythmic therapy. On multivariate analysis of clinical variables, time to cardioversion within 30 days after the onset of atrial arrhythmia was the only independent predictor of maintenance of sinus rhythm in the absence of antiarrhythmic drug therapy after a single ablation procedure (OR 22.5; 95% CI 4.87-103.88, P < 0.001).


CONCLUSIONS
Freedom from AF/flutter is achieved in approximately 50% of patients who undergo cardioversion within 30 days of a persistent atrial arrhythmia after catheter ablation of AF.
Baman
Timir S
TS
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Gupta
Sanjaya K
SK
Billakanty
Sreedhar R
SR
Ilg
Karl J
KJ
Good
Eric
E
Crawford
Thomas
T
Jongnarangsin
Krit
K
Ebinger
Matt
M
Pelosi
Frank
F
Bogun
Frank
F
Chugh
Aman
A
Morady
Fred
F
Oral
Hakan
H
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome