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.

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

GALLO, Cristina;BATTAGLIA, Alberto;ANSELMINO, Matteo;GIUSTETTO, Carla;CASTAGNO, Davide;GAITA, Fiorenzo
2014-01-01

Abstract

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.
2014
11
5
777
782
M. Scaglione; C. Gallo; A. Battaglia; D. Sardi; L. Gaido; M. Anselmino; L. Garberoglio; C. Giustetto; D. Castagno; F. Ferraris; E. Toso; F. Gaita.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/145048
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