Abstract 14355: Sinus Rhythm Prior to Catheter Ablation Positively Impacts Ablation Outcome in Non-Paroxysmal Atrial Fibrillation Patients
Background: Catheter ablation of non-paroxysmal atrial fibrillation (NPAF) is associated with longer procedure times and lower long-term success rates than that of paroxysmal AF. We tested the hypothesis that NPAF patients entering the EP laboratory (lab) with sinus rhythm (SR) have shorter procedure time and better ablation-outcome than those with AF as the entry-rhythm.
Methods: Total of 804 consecutive NPAF patients undergoing radiofrequency catheter ablation at our center were included in this prospective analysis. Based on the presenting rhythm in the EP lab, patients were classified into two groups; patients on SR (group 1, n=236, age 63±10 years, male 71%, LVEF 55.2±8.4, LA size 4.5±0.9 cm), patients in AF (group 2, n=568, age 64±10 years, male 69%, LVEF 54.4±11.4, LA size 4.6±0.6 cm). All patients were followed up for 38±6 months for arrhythmia recurrence by event recorder, ECG and Holter monitoring.
Results: The baseline characteristics were not different between the groups. When comparing the procedural parameters between the groups, patients presenting with SR required significantly shorter radiofrequency time (64.1±30.7 min vs. 82.3±29.4 min in AF group, p<0.0001) and procedure times (143.9±91.2 min vs. 162.3±62.2 min in AF group, p=0.019).
At the end of follow-up, significantly higher recurrence rate was noted in those presenting with AF compared to patients on SR at the procedure; 264 of 568 (47%) vs. 80 of 236 (34%) respectively, log-rank p=0.002 (unadjusted hazard ratio 1.55 [1.17 - 2.05]) (figure).
After adjusting for AF type, age, gender, LA size, and LVEF in multivariable Cox model, patients presenting with AF at procedure were twice more likely to fail compared to those on SR (hazard ratio 1.91 (95% CI 1.19 to 4.15), p=0.001).
Conclusion: Sinus rhythm prior to catheter ablation for non-paroxysmal AF decreases the duration of ablation and increases the long-term efficacy of the procedure.
Figure: Kaplan-Meier curve showing recurrence by study groups
Author Disclosures: S. Mohanty: None. P. Mohanty: None. C. Trivedi: None. C. Gianni: None. M.F. Gunes: None. Y. Gokoglan: None. R. Bai: None. J. Burkhardt: None. J. Sanchez: None. P. Hranitzky: None. G.J. Gallinghouse: None. A. Al-Ahmad: None. R. Horton: None. L. Di Biase: Consultant/Advisory Board; Modest; biosense-webster, hansen medical, st. jude medical, atricure, inc, EpiEP. A. Natale: Consultant/Advisory Board; Modest; janssen pharmaceuticals, biosense-webster, st. jude medical, medtronic, boston scientific corp..
- © 2015 by American Heart Association, Inc.