Different Determinants of the Recurrence of Atrial Fibrillation and Adverse Clinical Events in the Mid-Term Period After Atrial Fibrillation Ablation.
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Watanabe Ryuta, Nagashima Koichi, Wakamatsu Yuji, Otsuka Naoto, Yokoyama Katsuaki, Matsumoto Naoya, Otsuka Takayuki, Suzuki Shinya, Hirata Akio, Murakami Masato, Takami Mitsuru, Kimura Masaomi, Fukaya Hidehira, Nakahara Shiro, Kato Takeshi, Hayashi Hiroshi, Iwasaki Yu-Ki, Shimizu Wataru, Nakajima Ikutaro, Harada Tomoo, Koyama Junjiroh, Okumura Ken, Tokuda Michifumi, Yamane Teiichi, Tanimoto Kojiro, Momiyama Yukihiko, Nonoguchi Noriko, Soejima Kyoko, Ejima Koichiro, Hagiwara Nobuhisa, Harada Masahide, Sonoda Kazumasa, Inoue Masaru, Kumagai Koji, Hayashi Hidemori, Yazaki Yoshinao, Satomi Kazuhiro, Watari Yuji, Okumura Yasuo, AF Ablation Frontier Registry Investigators
Аннотация
METHODS AND RESULTS: We examined the data from a retrospective multicenter Japanese registry conducted at 24 cardiovascular centers between 2011 and 2017. Of the 3,451 patients (74.1% men; 63.3±10.3 years) who underwent AF ablation, 1,046 (30.3%) had AF recurrence and 224 (6.5%) suffered AEs (51 strokes/TIAs, 71 major bleeding events, and 36 deaths) over a median follow-up of 20.7 months. After multivariate adjustment, female sex, persistent and long-lasting persistent AF (vs. paroxysmal AF), and stepwise increased left atrial diameter (LAd) quartiles were significantly associated with post-ablation recurrences. A multivariate analysis revealed that an age ≥75 years (vs. <65 years), body weight <50 kg, diabetes, vascular disease, left ventricular (LV) ejection fraction <40% (vs. ≥50%), Lad ≥44 mm (vs. <36 mm), and creatinine clearance <50 mL/min were independently associated with AE incidences, but not with recurrences.
CONCLUSIONS: This study disclosed different determinants of post-ablation recurrence and AEs. Female sex, persistent AF, and enlarged LAd were determinants of post-ablation recurrence, whereas an old age, comorbidities, and LV and renal dysfunction rather than post-ablation recurrence were AEs determinants. These findings will help determine ablation indications and post-ablation management.