Incidence and significance of early recurrences associated with different ablation strategies for AF: a STAR-AF substudy.
BACKGROUND
Early recurrences of atrial tachyarrhythmias (ERAT) are common after atrial fibrillation (AF) ablation, and predict late recurrences (LR). We sought to determine the impact of different ablation strategies on ERAT and LR.


RESULTS
The STAR-AF trial randomized 100 patients with paroxysmal or persistent AF to ablation of complex fractionated electrograms (CFAE) alone, pulmonary vein isolation (PVI) alone, or combined PVI + CFAE. Patients were followed for 12 months. ERAT was defined as any recurrence of AF, atrial tachycardia, or flutter (AT/AFL) >30 seconds during the first 3 months of follow-up. LR was defined as any recurrence of AF/AT/AFL >30 seconds 3-12 months post. Forty-nine patients experienced ERAT. The index ablation strategy was the only independent predictor of ERAT on multivariate analysis (HR 2.24 PVI vs PVI + CFAE; and HR 2.65 CFAE vs PVI + CFAE). Fifty-two patients experienced LR. The presence of ERAT (HR 3.23), the use of antiarrhythmic drug (AAD) in the first 3 months postablation (HR 2.85), and the index ablation strategy were independently associated with LR (HR 3.42 PVI vs PVI + CFAE; HR 4.72 CFAE vs PVI + CFAE). Thirty-five of 49 (71%) patients with ERAT and 17 (33%) of 51 patients without ERAT had LR (P < 0.0001). Among patients with ERAT, increased left atrium size (HR 1.08), the use of AAD in the first 3 months postablation (HR 2.86) and the index ablation strategy were independently associated with LR (HR 4.77 PVI vs PVI + CFAE; HR 4.45 CFAE vs PVI + CFAE).


CONCLUSIONS
ERAT is common following AF ablation and is strongly associated with LR. Although CFAE ablation alone results in higher rates of early and LR, the addition of CFAE to PVI results in increased long-term success without an increase in ERAT.
Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
Jason G
JG
Andrade
Laurent
L
Macle
Paul
P
Khairy
Yaariv
Y
Khaykin
Roberto
R
Mantovan
Giuseppe
G
De Martino
Jian
J
Chen
Carlos A
CA
Morillo
Paul
P
Novak
Peter G
PG
Guerra
Girish
G
Nair
Esteban G
EG
Torrecilla
Atul
A
Verma
D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D038622:Internationality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome