Shorter AF episodes pre-ablation may lead to lower arrhythmia recurrence after procedure
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Patients who had atrial fibrillation episodes of less than 24 continuous hours had a lower incidence of arrhythmia recurrence after ablation compared with those with longer episodes, researchers found.
“These findings question the existing definition of paroxysmal AF, linking ablation outcomes to shorter AF durations,” Jason G. Andrade, MD, cardiologist and associate professor in the division of cardiology at the University of British Columbia in Vancouver, Canada, and assistant professor at Université de Montréal, told Healio. “This suggests that there is something different about AF patients with paroxysmal episodes lasting [less than] 24 hours relative to longer durations.”
CIRCA-DOSE study data
In this secondary analysis published in JAMA Network Open, researchers assessed data from 346 patients (mean age, 59 years; 68% men) from the CIRCA-DOSE study who had symptomatic AF and underwent catheter ablation. All patients received an implantable cardiac monitor at least 30 days before the procedure, which was used to quantify AF episode duration and burden, in addition to arrhythmia recurrence.
Follow-up was conducted for up to 1 year after the procedure and included a 12-lead ECG, clinical visits and supplementary 24-hour ambulatory ECG monitoring at 3, 6 and 12 months.
The primary outcome was time to first symptomatic or asymptomatic atrial tachyarrhythmia between 91 and 365 days after ablation or repeated ablation any time after the initial procedure. The secondary outcome was defined as post-ablation burden.
Of the patients in the study, 76% had an AF episode duration of less than 24 hours, 7.2% had episodes between 24 and 48 hours, 11.7% had episodes between 2 and 7 days, and 5.2% had episodes lasting more than 7 days.
Patients with AF episodes lasting less than 24 continuous hours at baseline were more likely to be free from recurrent atrial tachyarrhythmias after ablation compared with those with episodes lasting 24 to 28 hours (HR = 0.41; 95% CI, 0.21-0.8), episodes lasting 2 to 7 days (HR = 0.25; 95% CI, 0.14-0.45) and episodes lasting more than 7 days (HR = 0.23; 95% CI, 0.09-0.55).
Patients with baseline AF episodes of less than 24 continuous hours had a lower post-ablation AF burden (0%; 95% CI, 0-0.1) compared with those with baseline AF episodes lasting 2 to 7 days (0.1%; 95% CI, 0-1; P = .003) and those with baseline episodes lasting longer than 7 days (1%; 95% CI, 0-5.4; P = .008).
No difference in longer episode duration
Arrhythmia recurrence or AF burden did not significantly differ between the three groups with an AF episode duration longer than 24 hours at baseline.
“From a patient care standpoint, it suggests we may be able to use pre-ablation episode duration to better prognosticate procedural outcomes,” Andrade said in an interview.
Andrade added that further research is needed in this area. He told Healio, “Moving forward, it would be important to see these findings prospectively validated in a larger data set linking AF episode duration to other relevant patient outcomes (stroke, antiarrhythmic drug efficacy).”
For more information:
Jason G. Andrade, MD, can be reached at jason.andrade@vch.ca; Twitter: @drjasonandrade.
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