Clinical significance of early atrial arrhythmia type and timing after single ring isolation of the pulmonary veins.
OBJECTIVE
Early atrial arrhythmia following atrial fibrillation (AF) ablation is associated with higher recurrence rates. Few studies explore the impact of early AF (EAF) and atrial tachycardia (EAT) on long-term outcomes. Furthermore, EAF/EAT have not been characterized after wide pulmonary vein isolation. We aimed to characterize EAF and EAT and its impact on late AF (LAF) and AT (LAT) after single ring isolation (SRI).


RESULTS
We recruited 119 (females 21, age 58 ± 10 years) consecutive patients with AF (paroxysmal 76, persistent 43) undergoing SRI. Early atrial fibrillation/ early atrial tachycardia was defined as AF/AT within 3 months post-procedure (blanking period). Patients were followed for median 2.8[2.2-4] years. Early atrial fibrillation occurred in 28% (n = 33) and EAT in 25% (n = 30). At follow-up, 25% (n = 30) had LAF and 28% (n = 33) had LAT. Patients with EAF and EAT had higher rates of LAF (48 vs. 16%, P<0.0001) and LAT (60 vs. 16%, P < 0.0001), respectively. Independent predictors of LAF were EAF (3.53(1.72-7.29) P = 0.001); and of LAT were EAT (5.62(2.88-10.95) P < 0.0001) and procedure time (1.38/ h(1.07-1.78) P = 0.04). Importantly, EAF did not predict LAT and EAT did not predict LAF. Early atrial fibrillation late in the blanking period was associated with higher rates of LAF (73% for month 3 vs. 25% for Months 1-2, P = 0.004). However, EAT timing did not predict LAT.


CONCLUSIONS
Early atrial fibrillation and EAT are predictive of LAF and LAT, respectively. Early atrial fibrillation late in the blanking period has greater predictive significance for LAF. This timing is not relevant for LAT. Early arrhythmia type and timing have important prognostic significance following SRI.


BACKGROUND
http://www.anzctr.org.au;ACTRN12606000467538.
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.
Chrishan Joseph
CJ
Nalliah
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia Cardiac Department, National University Hospital, Singapore.
Toon Wei
TW
Lim
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.
Eddy
E
Kizana
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.
Pierre
P
Qian
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.
Pramesh
P
Kovoor
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.
Aravinda
A
Thiagalingam
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.
David Leslie
DL
Ross
Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia stuart.thomas@sydney.edu.au.
Stuart Phillip
SP
Thomas
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome
Atrial fibrillation; Blanking period; Catheter ablation; Early recurrence of atrial fibrillation; Early recurrence of atrial tachycardia; Pulmonary vein isolation