Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation

TY - JOUR

T1 - Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation

AU - Alhede, Christina

AU - Johannessen, Arne

AU - Dixen, Ulrik

AU - Jensen, Jan S.

AU - Raatikainen, Pekka

AU - Hindricks, Gerhard

AU - Walfridsson, Håkan

AU - Kongstad, Ole

AU - Pehrson, Steen

AU - Englund, Anders

AU - Hartikainen, Juha

AU - Hansen, Peter S.

AU - Nielsen, Jens C.

AU - Jons, Christian

PY - 2018

Y1 - 2018

N2 - Early identification of patients who could benefit from early re-intervention after catheter ablation is highly warranted. Our aim was to investigate the association between post-procedural burden of supraventricular ectopic complexes (SVEC) and the risk of long-term atrial fibrillation (AF) recurrence. A total of 125 patients undergoing catheter ablation for AF were included. Patients underwent 7-day Holter recordings immediately post-procedural. The number of SVEC in post-procedural Holter recordings was categorized into quartiles: 0-72, 73-212, 213-782 and≥783 SVEC/day. Long-term AF recurrence was defined as a combined endpoint of AF≥1 min during follow-up Holter recordings, cardioversion or hospitalization for AF after a 3-month blanking period and within 24 months of follow-up. High post-procedural supraventricular ectopy burden was associated with an increased risk of long-term AF recurrence in a dose-dependent manner (≥783 SVEC: HR 4.6 [1.9-11.5], P<0.001) irrespective of AF recurrence during the blanking period or other risk factors. In patients with early AF recurrence<90 days after catheter ablation ectopy burden was also highly predictive of long-term AF recurrence (SVEC≥213: HR 3.0 [1.3-6.7], P=0.007). Correspondingly, patients with early AF recurrence but low ectopy burden remained at low risk of long-term AF recurrence after the blanking period. Our results indicate that post-procedural ectopy burden is highly associated with long-term AF recurrence and could be a potent risk marker for selection of patients for early re-ablation. Development of future ablation risk stratification and strategies should include focus on post-procedural ectopy burden.

AB - Early identification of patients who could benefit from early re-intervention after catheter ablation is highly warranted. Our aim was to investigate the association between post-procedural burden of supraventricular ectopic complexes (SVEC) and the risk of long-term atrial fibrillation (AF) recurrence. A total of 125 patients undergoing catheter ablation for AF were included. Patients underwent 7-day Holter recordings immediately post-procedural. The number of SVEC in post-procedural Holter recordings was categorized into quartiles: 0-72, 73-212, 213-782 and≥783 SVEC/day. Long-term AF recurrence was defined as a combined endpoint of AF≥1 min during follow-up Holter recordings, cardioversion or hospitalization for AF after a 3-month blanking period and within 24 months of follow-up. High post-procedural supraventricular ectopy burden was associated with an increased risk of long-term AF recurrence in a dose-dependent manner (≥783 SVEC: HR 4.6 [1.9-11.5], P<0.001) irrespective of AF recurrence during the blanking period or other risk factors. In patients with early AF recurrence<90 days after catheter ablation ectopy burden was also highly predictive of long-term AF recurrence (SVEC≥213: HR 3.0 [1.3-6.7], P=0.007). Correspondingly, patients with early AF recurrence but low ectopy burden remained at low risk of long-term AF recurrence after the blanking period. Our results indicate that post-procedural ectopy burden is highly associated with long-term AF recurrence and could be a potent risk marker for selection of patients for early re-ablation. Development of future ablation risk stratification and strategies should include focus on post-procedural ectopy burden.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Atrial premature complexes

KW - Recurrence

KW - Treatment

U2 - 10.1093/europace/euw329

DO - 10.1093/europace/euw329

M3 - Journal article

C2 - 28011799

AN - SCOPUS:85040770698

SN - 1099-5129

VL - 20

SP - 50

EP - 57

JO - Europace

JF - Europace

IS - 1

ER -