Ultra-Early Recurrence of Atrial Fibrillation After Direct Cardioversion Predicts Late Recurrence After Ablation for...

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Immediate recurrence of atrial fibrillation (IRAF) after cardioversion is a proposed marker for atrial substrate vulnerability.
• The broad definition of IRAF may not sufficiently identify patients at high risk for post-ablation recurrence.
• Ultra-early recurrence of AF (URAF), defined as recurrence within 10 seconds post-cardioversion, is introduced as a novel marker for advanced atrial remodeling in persistent AF.

Purpose of the Study:

• To evaluate if URAF independently predicts late recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI).
• To assess URAF as a predictor in patients with persistent or long-standing persistent AF undergoing PVI.

Main Methods:

• Retrospective analysis of 104 patients undergoing first-time PVI for persistent AF.
• URAF and IRAF were defined as AF recurrence within 10 and 90 seconds, respectively, after external cardioversion (CV) in 93 patients.
• Atrial arrhythmia recurrence was assessed at 12 months post-ablation.

Main Results:

• URAF occurred in 9.6% of patients and was significantly associated with higher 12-month recurrence rates (50% vs. 18%, p=0.02).
• IRAF (19.2%) did not show a significant difference in recurrence rates (30% vs. 19%, p=0.28).
• Multivariable analysis identified URAF (OR 4.8) and long-standing AF (OR 5.5) as independent predictors of recurrence. Kaplan-Meier analysis showed worse recurrence-free survival for URAF (HR 4.5, p=0.02).

Conclusions:

• URAF shows promise as an intra-procedural marker predicting post-ablation recurrence in persistent AF.
• Prospective validation in larger cohorts is necessary to confirm these findings.