Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation

Guan Yi Li; Ahmed Moustafa Elimam; Li Wei Lo; Yenn Jiang Lin; Shih Lin Chang; Yu Feng Hu; Fa Po Chung; Tze Fan Chao; Chin Yu Lin; Chih Min Liu; Jo Nan Liao; An Khanh Nu Ton; Dony Yugo; Linda Lin; Ta Chuan Tuan; Pei Heng Kao; Shin Huei Liu; Chheng Chhay; Ling Kuo; Wen Han Cheng; Wei Tso Chen; Shih Ann Chen

doi:10.1111/jce.16100

Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation

Guan Yi Li, Ahmed Moustafa Elimam, Li Wei Lo^*, Yenn Jiang Lin, Shih Lin Chang, Yu Feng Hu, Fa Po Chung, Tze Fan Chao, Chin Yu Lin, Chih Min Liu, Jo Nan Liao, An Khanh Nu Ton, Dony Yugo, Linda Lin, Ta Chuan Tuan, Pei Heng Kao, Shin Huei Liu, Chheng Chhay, Ling Kuo, Wen Han ChengWei Tso Chen, Shih Ann Chen

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Introduction: Despite undergoing an index ablation, some patients progress from paroxysmal atrial fibrillation (PAF) to persistent AF (PersAF), and the mechanism behind this is unclear. The aim of this study was to investigate the predictors of progression to PersAF after catheter ablation in patients with PAF. Methods: This study included 400 PAF patients who underwent an index ablation between 2015 and 2019. The patients were classified into three groups based on their outcomes: Group 1 (PAF to sinus rhythm, n = 226), Group 2 (PAF to PAF, n = 146), and Group 3 (PAF to PersAF, n = 28). Baseline and procedural characteristics were collected, and predictors for AF recurrence and progression were evaluated. Results: The mean age of the patients was 58.4 ± 11.1 years, with 272 males. After 3 years of follow-up, 7% of the PAF cases recurred and progressed to PersAF despite undergoing an index catheter ablation. In the multivariable analysis, a larger left atrial (LA) diameter and the presence of non-pulmonary vein (PV) triggers during the index procedure independently predicted recurrence. Moreover, a larger LA diameter, the presence of non-PV triggers, and a history of thyroid disease independently predicted AF progression. Conclusion: The progression from PAF to PersAF after catheter ablation is associated with a larger LA diameter, history of thyroid disease, and the presence of non-PV triggers. Meticulous preprocedural evaluation, patient selection, and comprehensive provocation tests during catheter ablation are recommended.

Original language	English
Pages (from-to)	2504-2513
Number of pages	10
Journal	Journal of cardiovascular electrophysiology
Volume	34
Issue number	12
DOIs	https://doi.org/10.1111/jce.16100
State	Published - Dec 2023

Keywords

atrial fibrillation
catheter ablation
left atrium
non-pulmonary vein trigger
progression
recurrence
thyroid

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10.1111/jce.16100

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Li, G. Y., Elimam, A. M., Lo, L. W., Lin, Y. J., Chang, S. L., Hu, Y. F., Chung, F. P., Chao, T. F., Lin, C. Y., Liu, C. M., Liao, J. N., Ton, A. K. N., Yugo, D., Lin, L., Tuan, T. C., Kao, P. H., Liu, S. H., Chhay, C., Kuo, L., ... Chen, S. A. (2023). Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation. Journal of cardiovascular electrophysiology, 34(12), 2504-2513. https://doi.org/10.1111/jce.16100

@article{47e75ba0a36d4861b0cb25ce6e19f894,

title = "Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation",

abstract = "Introduction: Despite undergoing an index ablation, some patients progress from paroxysmal atrial fibrillation (PAF) to persistent AF (PersAF), and the mechanism behind this is unclear. The aim of this study was to investigate the predictors of progression to PersAF after catheter ablation in patients with PAF. Methods: This study included 400 PAF patients who underwent an index ablation between 2015 and 2019. The patients were classified into three groups based on their outcomes: Group 1 (PAF to sinus rhythm, n = 226), Group 2 (PAF to PAF, n = 146), and Group 3 (PAF to PersAF, n = 28). Baseline and procedural characteristics were collected, and predictors for AF recurrence and progression were evaluated. Results: The mean age of the patients was 58.4 ± 11.1 years, with 272 males. After 3 years of follow-up, 7% of the PAF cases recurred and progressed to PersAF despite undergoing an index catheter ablation. In the multivariable analysis, a larger left atrial (LA) diameter and the presence of non-pulmonary vein (PV) triggers during the index procedure independently predicted recurrence. Moreover, a larger LA diameter, the presence of non-PV triggers, and a history of thyroid disease independently predicted AF progression. Conclusion: The progression from PAF to PersAF after catheter ablation is associated with a larger LA diameter, history of thyroid disease, and the presence of non-PV triggers. Meticulous preprocedural evaluation, patient selection, and comprehensive provocation tests during catheter ablation are recommended.",

keywords = "atrial fibrillation, catheter ablation, left atrium, non-pulmonary vein trigger, progression, recurrence, thyroid",

author = "Li, {Guan Yi} and Elimam, {Ahmed Moustafa} and Lo, {Li Wei} and Lin, {Yenn Jiang} and Chang, {Shih Lin} and Hu, {Yu Feng} and Chung, {Fa Po} and Chao, {Tze Fan} and Lin, {Chin Yu} and Liu, {Chih Min} and Liao, {Jo Nan} and Ton, {An Khanh Nu} and Dony Yugo and Linda Lin and Tuan, {Ta Chuan} and Kao, {Pei Heng} and Liu, {Shin Huei} and Chheng Chhay and Ling Kuo and Cheng, {Wen Han} and Chen, {Wei Tso} and Chen, {Shih Ann}",

note = "Publisher Copyright: {\textcopyright} 2023 Wiley Periodicals LLC.",

year = "2023",

month = dec,

doi = "10.1111/jce.16100",

language = "English",

volume = "34",

pages = "2504--2513",

journal = "Journal of cardiovascular electrophysiology",

issn = "1045-3873",

publisher = "John Wiley and Sons Inc.",

number = "12",

}

Li, GY, Elimam, AM, Lo, LW, Lin, YJ, Chang, SL , Hu, YF, Chung, FP, Chao, TF, Lin, CY, Liu, CM, Liao, JN, Ton, AKN, Yugo, D, Lin, L, Tuan, TC, Kao, PH, Liu, SH, Chhay, C, Kuo, L, Cheng, WH, Chen, WT & Chen, SA 2023, 'Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation', Journal of cardiovascular electrophysiology, vol. 34, no. 12, pp. 2504-2513. https://doi.org/10.1111/jce.16100

TY - JOUR

T1 - Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation

AU - Li, Guan Yi

AU - Elimam, Ahmed Moustafa

AU - Lo, Li Wei

AU - Lin, Yenn Jiang

AU - Chang, Shih Lin

AU - Hu, Yu Feng

AU - Chung, Fa Po

AU - Chao, Tze Fan

AU - Lin, Chin Yu

AU - Liu, Chih Min

AU - Liao, Jo Nan

AU - Ton, An Khanh Nu

AU - Yugo, Dony

AU - Lin, Linda

AU - Tuan, Ta Chuan

AU - Kao, Pei Heng

AU - Liu, Shin Huei

AU - Chhay, Chheng

AU - Kuo, Ling

AU - Cheng, Wen Han

AU - Chen, Wei Tso

AU - Chen, Shih Ann

PY - 2023/12

Y1 - 2023/12

N2 - Introduction: Despite undergoing an index ablation, some patients progress from paroxysmal atrial fibrillation (PAF) to persistent AF (PersAF), and the mechanism behind this is unclear. The aim of this study was to investigate the predictors of progression to PersAF after catheter ablation in patients with PAF. Methods: This study included 400 PAF patients who underwent an index ablation between 2015 and 2019. The patients were classified into three groups based on their outcomes: Group 1 (PAF to sinus rhythm, n = 226), Group 2 (PAF to PAF, n = 146), and Group 3 (PAF to PersAF, n = 28). Baseline and procedural characteristics were collected, and predictors for AF recurrence and progression were evaluated. Results: The mean age of the patients was 58.4 ± 11.1 years, with 272 males. After 3 years of follow-up, 7% of the PAF cases recurred and progressed to PersAF despite undergoing an index catheter ablation. In the multivariable analysis, a larger left atrial (LA) diameter and the presence of non-pulmonary vein (PV) triggers during the index procedure independently predicted recurrence. Moreover, a larger LA diameter, the presence of non-PV triggers, and a history of thyroid disease independently predicted AF progression. Conclusion: The progression from PAF to PersAF after catheter ablation is associated with a larger LA diameter, history of thyroid disease, and the presence of non-PV triggers. Meticulous preprocedural evaluation, patient selection, and comprehensive provocation tests during catheter ablation are recommended.

AB - Introduction: Despite undergoing an index ablation, some patients progress from paroxysmal atrial fibrillation (PAF) to persistent AF (PersAF), and the mechanism behind this is unclear. The aim of this study was to investigate the predictors of progression to PersAF after catheter ablation in patients with PAF. Methods: This study included 400 PAF patients who underwent an index ablation between 2015 and 2019. The patients were classified into three groups based on their outcomes: Group 1 (PAF to sinus rhythm, n = 226), Group 2 (PAF to PAF, n = 146), and Group 3 (PAF to PersAF, n = 28). Baseline and procedural characteristics were collected, and predictors for AF recurrence and progression were evaluated. Results: The mean age of the patients was 58.4 ± 11.1 years, with 272 males. After 3 years of follow-up, 7% of the PAF cases recurred and progressed to PersAF despite undergoing an index catheter ablation. In the multivariable analysis, a larger left atrial (LA) diameter and the presence of non-pulmonary vein (PV) triggers during the index procedure independently predicted recurrence. Moreover, a larger LA diameter, the presence of non-PV triggers, and a history of thyroid disease independently predicted AF progression. Conclusion: The progression from PAF to PersAF after catheter ablation is associated with a larger LA diameter, history of thyroid disease, and the presence of non-PV triggers. Meticulous preprocedural evaluation, patient selection, and comprehensive provocation tests during catheter ablation are recommended.

KW - atrial fibrillation

KW - catheter ablation

KW - left atrium

KW - non-pulmonary vein trigger

KW - progression

KW - recurrence

KW - thyroid

UR - http://www.scopus.com/inward/record.url?scp=85173904844&partnerID=8YFLogxK

U2 - 10.1111/jce.16100

DO - 10.1111/jce.16100

M3 - Article

C2 - 37822117

AN - SCOPUS:85173904844

SN - 1045-3873

VL - 34

SP - 2504

EP - 2513

JO - Journal of cardiovascular electrophysiology

JF - Journal of cardiovascular electrophysiology

IS - 12

ER -

Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation

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