Abstract 14870: Progression of Paroxysmal to Persistent Af in Patients Awaiting AF Ablation
Objective: Atrial fibrillation (AF) is a progressive disease for which ablation has become an important treatment option. Success rates have been shown to be significantly higher while AF has not yet progressed to persistent. In a general AF-population the HATCH-score has been proposed to predict the risk of progression to persistent AF. However, little is known about predictors of progression in patients awaiting AF ablation.
Methods/Results: We performed a retrospective, single centre investigation of patients with paroxysmal AF at the time they were placed onto our AF ablation waiting list and evaluated possible risk factors for the progression of AF until the time of the actual ablation.
Of 564 patients (median age 60.4 (±15.1) years, 194 (34.4%) female) 60 (11%) progressed from paroxysmal to persistent AF during a median waiting time of 291 (±244.3) days. In patients that progressed to persistent AF, ablation took significantly longer (180±99 min vs. 157±85min; p 0.009), had a tendency to require longer RF-energy delivery (68.9±40 min vs. 61.8±44 min; p 0.052) and was associated with a higher rate of recurrence (53.3% vs. 39.1%; p<0.001). Patients that did progress to persistent AF had tied significantly more antiarrhythmic drugs (1 (±2) vs. 1(±1); p 0,048) and more frequently had a history of amiodaron treatment (21.7% vs. 11.9%; p 0.03).
The previously proposed HATCH-score was only a poor predictor of AF progression (AUC 0.54). Furthermore, none of the individual HATCH-score parameters was a significantly predicted the progression of AF in our population. However, a left atrial (LA) diameter of more than 45mm (OR 3.46, p< 0.001) and heart failure (OR 3.11, p 0.036) were strong and independent predictors of AF progression in multivariable analysis.
Conclusion: Patients with an increased LA-diameter or heart failure have a significantly increased risk to progress to persistent AF. If ablation is considered in such a patient it should be conducted as soon as possible to prevent progression to persistent AF.
Author Disclosures: S. Kochhaeuser: None. D. Dechering: None. K. Trought: None. P. Hache: None. T. Haig-Carter: None. Y. Khaykin: None. Z. Wulffhart: Speakers Bureau; Modest; Boehringer Ingelheim, Bayer. A. Pantano: None. B. Tsang: None. B. Tsang: None. L. Eckardt: Research Grant; Modest; Biotronik, St. Jude Medical, Sanofi, Osypka. A. Verma: Research Grant; Modest; Bayer, Boehringer Ingelheim. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Bayer.
- © 2015 by American Heart Association, Inc.