LONG-TERM PROGRESSION TO PERMANENT ATRIAL FIBRILLATION FOLLOWING TRANSCATHETER ABLATION: A LARGE SINGLE CENTER EXPERIENCE

Introduction: Natural history of atrial fibrillation (AF) is characterized by a gradual duration and frequency increase of relapses until the definitive shift to permanent AF. Heart disease and comorbidities modulate AF progression. Our aim is to identify long-term predictors of AF progression in a large cohort of patients undergoing AF transcatheter ablation (AFTCA). Methods: Eight hundred eighty-nine patients (mean age 57±11 years, 53.3% paroxysmal, 40.5% persistent and 6.2% long-standing AF) underwent AFTCA. All patients received pulmonary vein isolation while linear lesions were reserved for cardiomyopathies/comorbidities, Persistent/long lasting AF or in case of redo procedures. Results: After a median follow up of 61 (38-84) months, AF progression occurred in 57 (6.4%) cases. Stratifying by baseline AF subtype an increasing trend in arrhythmia progression emerged: 2.7% of patients with paroxysmal, compared to 10.0% with persistent and 14.6% with long-standing AF (p<0.001). AF progression was reported in 9.1% of the 623 (70.1%) patients presenting baseline comorbidities/cardiomyopathies but in none of 266 (29.9%) with lone AF (Figure, p<0.001). At multivariate analysis only cardiomyopathies/comorbidities and baseline persistent/long standing AF were independent predictors of progression (OR 11.3 CI 95% 2.6-48 p<0.001 and OR 1.6 CI 95% 1.2-2.1 p<0.001). Conclusions: Cardiomyopathies/comorbidities and an AF clinical history more advanced than a paroxysmal form predict AF progression, despite AFTCA, over a long-term follow-up