Fact checked byRichard Smith

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September 22, 2023
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Persistent AF independently predicts poor outcomes after catheter ablation

Fact checked byRichard Smith
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Key takeaways:

  • Persistent atrial fibrillation was an independent predictor of poor outcomes after catheter ablation.
  • Ablation of paroxysmal AF conferred more quality of life benefit vs. ablation of persistent AF.

Persistent atrial fibrillation was associated with worse outcomes and less quality of life benefit after catheter ablation compared with paroxysmal AF, researchers reported.

In addition, the benefit of catheter ablation compared with medical therapy was not significant among patients with long-standing AF, according to research published in the Journal of the American Heart Association.

Atrial fibrillation smartphone
Persistent atrial fibrillation was an independent predictor of poor outcomes after catheter ablation.
Image: Adobe Stock

“From the perspective of the efficacy of catheter ablation, paroxysmal AF has conventionally been a preferred indication over persistent AF, with a recent increase in reports supporting rhythm control emphasizing this trend, especially for those with early AF (ie, first AF episode, recent-onset AF and paroxysmal AF),” Hiroshi Miyama, MD, PhD, of the department of cardiology at Keio University School of Medicine in Tokyo, and colleagues wrote. “However, catheter ablation is selectively performed for patients with persistent AF in daily clinical practice, whereas the subanalysis of randomized controlled trials for direct oral anticoagulants has revealed the poor cardiovascular prognosis of patients with persistent AF compared with that of patients with paroxysmal AF over the past decade. At this point, there is still a lack of insight into prognostic differences, including patients’ health status (ie, health-related quality of life) and the consequences of undergoing catheter ablation by the type of AF.”

Using data from the Keio Interhospital Studies-Atrial Fibrillation registry, Miyana and colleagues categorized 2,788 patients as having paroxysmal AF or persistent AF based on AF duration.

The researchers compared occurrences of the composite outcome of all-cause death, HF hospitalization, stroke, bleeding and change in Atrial Fibrillation Effect on Quality-of-Life (AFEQT) score during 2 years of follow-up between patients with paroxysmal AF or persistent AF.

Overall, 51.6% of patients were diagnosed with paroxysmal AF and 48.4% were diagnosed with persistent AF.

Ablation prognosis by AF type

Patient with persistent AF were more often older, male and with higher BMI compared with those with paroxysmal AF. Patient with persistent AF also had a higher burden of comorbidities, including hypertension, diabetes and chronic kidney disease, as well as histories of HF and stroke or transient ischemic attack.

The researchers reported that patients with persistent AF had a higher incidence of the composite outcome compared with patients with paroxysmal AF (12.8% vs. 7.2%; P < .001) and was primarily driven by greater HF hospitalizations (6.2% vs. 2.6%; P < .001).

Patients with persistent AF also experienced smaller improvements in AFEQT scores compared with those with paroxysmal AF, including symptoms, daily activity, treatment concerns and satisfaction scores.

Moreover, the researchers determined that persistent AF was an independent predictor of adverse outcomes (adjusted HR = 1.35; 95% CI, 1.3-1.78; P = .031) and poor improvements in AFEQT.

In a subanalysis for which researchers compared outcomes after catheter ablation with medical therapy between the two AF groups, patients with paroxysmal AF who underwent catheter ablation experienced fewer adverse events (OR = 0.31; 95% CI, 0.18-0.68; P = .002). Although the pattern of event reduction with catheter ablation in patients with persistent AF was similar, the trend was not significant.

Indications for persistent AF ablation ‘require deliberate consideration’

“Patients with persistent AF showed significantly worse clinical outcomes at 2 years compared with those with paroxysmal AF and were associated with less improvement in health-related quality of life,” the researchers wrote. “The present results suggest the pathogenicity of long-standing AF, which can be a rationale for intervention, including catheter ablation, to prevent adverse clinical events and disease progression in the early stages of AF (ie, paroxysmal AF), while the indications for catheter ablation in those with persistent AF require deliberate consideration.”