Incidence, characteristics, and prognostic significance of early recurrences after different ablation approaches for persistent atrial fibrillation.

Background: Early recurrence of atrial tachyarrhythmia (ERAT) is common after catheter ablation of atrial fibrillation (AF). The specific clinical and arrhythmia characteristics of ERAT influencing late recurrence risk in persistent AF are unclear. In addition, the impact of different ablation strategies on the incidence and prognostic significance of ERAT remains unknown.

Objective: This study aimed to assess the incidence, characteristics, and prognostic impact of ERAT in patients with persistent AF undergoing pulmonary vein isolation alone or pulmonary vein isolation with posterior wall isolation.

Methods: Trial participants monitored by implantable cardiac devices or twice-daily electrocardiogram transmissions were included. Atrial arrhythmia recurrences lasting ≥30 seconds were classified as ERAT (within 3 months after ablation) or late recurrence (between 3 and 12 months).

Results: Of the 282 included patients, ERAT occurred in 124 (44.0%). ERAT portended an increased incidence of late recurrence (68.5% vs 32.9%; hazard ratio, 3.36; 95% confidence interval, 2.35-4.79) and significantly higher post-blanking period AF burden (median, 0.66% [interquartile range, 0-8.35%] vs 0% [0-0.55%]). The hazard ratio for late recurrence was 2.34 (1.48-3.71), 2.89 (1.63-5.12), and 6.00 (3.86-9.32) when the latest ERAT occurred in the first, second, and third month, respectively. Late recurrence risk was particularly elevated in patients with high-burden, frequent, or symptomatic ERAT. Ablation strategy did not affect the incidence, burden, arrhythmia characteristics, or prognostic significance of ERAT.

Conclusion: ERAT after radiofrequency ablation of persistent AF is an independent predictor of late recurrence and increased post-blanking period AF burden. An individualized assessment of early recurrences is warranted to critically evaluate their clinical significance.