Abstract 18742: Pulmonary Vein Isolation Prevents Atrial Fibrillation Progression but Does Not Improve Cardiovascular Outcome in Patients With Young-Onset Atrial Fibrillation
Introduction: Pulmonary vein isolation (PVI) is used to reduce symptoms in recurrent atrial fibrillation (AF), especially in younger patients. We aim to study the long-term effects of PVI on progression to permanent AF and cardiovascular outcomes in patients with young-onset AF.
Methods: We included 468 patients with young-onset paroxysmal or persistent AF <60 years of age. Data on progression to permanent AF, PVI and cardiovascular outcomes were prospectively collected. Kaplan-Meier curves were created and log rank tests were performed to compare PVI and non-PVI groups for progression and cardiovascular outcome.
Results: Mean age was 49±9 years and 304 (74%) had paroxysmal AF. Median AF history was 14 [3-35] months and 354 (76%) were men. Median CHA2DS2-VASc score was 1 [0-2], left ventricular ejection fraction was good (60 [55-60]%); left atrial size was 41mm; 44 (9%) had heart failure; 207 (44%) had hypertension. In total, 200 (43%) patients had one or more PVIs. Patients with PVI had a higher body mass index (28 [25-30] vs 27 [24-30]; p=0.036) and a longer history of AF (19 [5-42] vs 11 [2-31]; p=0.001). During median follow up of 7.2 [2.7-10.0] years, progression to permanent AF occurred in 56 (12%) patients. Patients with PVI had less AF progression (Figure 1; 9 [5%] vs 47 [18%]; HR 0.50 [0.32-0.76]; p<0.001). In a model corrected for anti-arrhythmic drugs, electrical cardioversion, number of months since diagnosis of AF and sex, this relation remained significant (HR 0.48 [0.31-0.74]; p<0.001). A total of 64 adverse events were observed, mainly pacemaker implantations (25 [5%]) and heart failure admissions (16 [3%]). There was no difference in overall cardiovascular outcomes between groups (PVI: 28 [14%], no PVI: 36 [13%], p=0.89), nor in individual components of outcome.
Conclusions: Patients with young-onset AF had less AF progression after PVI but no differences in cardiovascular outcomes were observed.
Author Disclosures: R.R. De With: None. Y. Blaauw: None. M.I. Al-Jazairi: None. J.N. Wessels: None. I.C. Van Gelder: None. M. Rienstra: None.
- © 2016 by American Heart Association, Inc.