Long-term progression from paroxysmal to permanent Atrial Fibrillation following transcatheter ablation in a large single center experience

BACKGROUND: Natural history of atrial fibrillation (AF) is characterized by gradual increase in duration and frequency of relapses until a definitive shift to permanent AF. Heart disease and comorbidities modulate AF progression, however, to date, the influence of catheter ablation on AF evolution has rarely been investigated. OBJECTIVE: Our aim is to identify long-term predictors of AF progression in a large cohort of patients undergoing transcatheter AF ablation (AFTCA). METHODS: 889 patients (mean age 57±11 years, 53.3% paroxysmal, 40.5% persistent and 6.2% long-standing AF) underwent AFTCA. All patients received pulmonary veins isolation while linear lesions and complex fractionated atrial electrograms ablation were reserved for patients with persistent/long-standing AF and/or in confirmed structural heart disease. RESULTS: After a median follow up of 64 (41-84) months, AF progression despite AFTCA occurred in 57 (6.4%) cases. However, AF progression was much more pronounced in patients afflicted by persistent (10%) and long-standing persistent AF (14,6%) compared to patients afflicted by paroxysmal AF (2,7%, p<0.001). Furtheremore, AF progression was more frequently reported in patients presenting with underlying comorbidities/cardiomyopathies (9.1%)compared to those presenting with lone AF (29.9%, p<0.001). At multivariate analysis, comorbidities/cardiomyopathies and baseline persistent/long-standing AF proved as independent predictors of progression (OR 11.3, CI 95% 2.6-48.0, p<0.001 and OR 1.6, CI 95% 1.2-2.1, p<0.001 respectively). CONCLUSIONS: The presence of comorbidities/cardiomyopathies and persistent/long-standing AF seem to predict AF progression in patients undergoing AFTCA. Performing AFCTA in the paroxysmal phase of the arrhythmia may reduce progression of AF to its permanent form.