Clinical predictors and relationship between early and late atrial tachyarrhythmias after pulmonary vein antrum isolation

BackgroundSeveral studies have reported early (EAT) and late (LAT) atrial tachyarrhythmias following atrial fibrillation (AF) ablation, but the factors associated with them and their clinical significance are not well known.ObjectiveThe purpose of this study was to investigate the predictors and the relationship between EAT and LAT after AF ablation.MethodsA total of 1298 patients with paroxysmal (54%), persistent (18%), or permanent (28%) AF underwent intracardiac echocardiography-guided pulmonary vein antrum isolation and were followed for 41 ± 10 months. EAT and LAT were defined as an episode of AF or atrial flutter/tachycardia lasting longer than 1 minute that occurred within the first 3 months of ablation and after 3 months postablation, respectively.ResultsAfter a single ablation procedure, EAT developed in 514 (40%) patients and LAT in 292 (22%) patients. At a multivariable analysis, longer AF duration (odds ratio [OR] 1.03), history of hypertension (OR 1.32), left atrial enlargement (OR 1.55), permanent AF (OR 1.72), and lack of superior vena cava isolation (OR 1.60) were significantly associated with EAT. Independent predictors of LAT were longer AF duration (OR 1.03), history of hypertension (OR 1.65), persistent (OR 2.17) or permanent AF (OR 2.28), and occurrence of EAT (OR 30.62). The risk of LAT was inversely related to the time to first EAT occurrence (OR 20, 54, and 1,052 in first, second, and third month, respectively). Notably, 49% of patients with EAT did not experience LAT.ConclusionEAT strongly predict LAT. However, EAT did not automatically mean ablation failure. Delaying redo procedure may be appropriate during the first 2 months after ablation. Longer AF duration, hypertension, and nonparoxysmal AF are independent predictors of EAT and LAT.