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Presence of sinus rhythm at time of ablation in patients with persistent atrial fibrillation undergoing pulmonary vein isolation is associated with improved long-term arrhythmia outcomes

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Abstract

Background

Adverse structural and electrical remodeling underlie persistent atrial fibrillation (PersAF). Restoration of sinus rhythm (SR) prior to ablation in PersAF may improve the underlying substrate, thus improving arrhythmia outcomes. The aim of this study was to evaluate if the presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of a limited catheter ablation (CA) strategy in PersAF.

Methods

Patients with PersAF undergoing pulmonary vein isolation at our institution from 2014–2018 were included. We compared patients who presented for ablation in SR (by cardioversion and/or antiarrhythmic drugs [AADs]) to those who presented in AF. Primary outcome of interest was freedom from atrial arrhythmias (AAs) on or off AADs at 1 year after single ablation. Secondary outcomes included freedom from AAs on or off AADs overall, freedom from AAs off AADs at 1 year, and time to recurrent AF.

Results

Five hundred seventeen patients were included (322 presented in AF, 195 SR). The primary outcome was higher in those who presented for CA in SR as compared to AF (85.6% vs. 77.0%, p = 0.017). Freedom from AAs off AAD at 12 months was also higher in those presenting in SR (59.0% vs. 44.4%; p = 0.001) and time to recurrent AF was longer (p = 0.008). Presence of SR at CA was independently associated with the primary outcome at 12 months (OR 1.77; 95% CI 1.08–2.90) and overall (OR 1.89; 95% CI 1.26–2.82).

Conclusions

Presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of limited CA in PersAF.

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Abbreviations

AAD:

Antiarrhythmic drugs

AF:

Atrial fibrillation

CA:

Catheter ablation

LA:

Left atrial

pAF:

Paroxysmal atrial fibrillation

PersAF:

Persistent atrial fibrillation

PVI:

Pulmonary vein isolation

SD:

Standard deviation

SR:

Sinus rhythm

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Funding

This work was supported by the Richard T. and Angela Clark Innovation Fund in Cardiovascular Medicine and the Pennsylvania Steel Company EP Research Fund.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA

    Lauren A. Eberly

  2. Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, USA

    Lauren A. Eberly

  3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA

    Lauren A. Eberly

  4. Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA

    Aung Lin, Mirmilad Khoshnab, Jennifer Chee, Katie Walsh, Gregory E. Supple, Robert D. Schaller, Pasquale Santangeli, Michael P. Riley, Saman Nazarian, Jeffrey Arkles, Matthew Hyman, David Lin, Gustavo Guandalini, Ramanan Kumareswaran, Rajat Deo, Erica S. Zado, Andrew Epstein, David S. Frankel, David J. Callans, Francis E. Marchlinski & Sanjay Dixit

  5. Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA

    Joseph Park

  6. Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz, Aurora, USA

    Lohit Garg

  7. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

    Michael J. Kallan

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  1. Lauren A. Eberly
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Corresponding author

Correspondence to Sanjay Dixit.

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This registry is approved by the University of Pennsylvania institutional review board and all patients provided written informed consent both for the ablation procedure and for their data to be used for research purposes.

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The authors declare no competing interests.

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Eberly, L.A., Lin, A., Park, J. et al. Presence of sinus rhythm at time of ablation in patients with persistent atrial fibrillation undergoing pulmonary vein isolation is associated with improved long-term arrhythmia outcomes. J Interv Card Electrophysiol 66, 1455–1464 (2023). https://doi.org/10.1007/s10840-022-01441-4

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