Recurrence of Atrial Fibrillation/Flutter Over Long‐Term Follow‐Up After Index Atrial Fibrillation Catheter Ablation

BACKGROUND: Data on atrial fibrillation (AF)/flutter (AFL) recurrence over long-term follow-up after catheter ablation of AF are limited. OBJECTIVE: Assess the rate, predictors, and temporal trends of long-term post-ablation AF/AFL recurrence. METHODS: We analyzed consecutive first-time AF catheter ablations between 2008 and 2022 at our center who were captured in our AF ablation registry and outcomes data were supplemented with chart review. Multivariable predictors of any clinically documented AF/AFL after 3-month blanking period were identified with a stepwise-selection multivariable proportional-hazards model in randomly selected 70% data set and validated in remaining 30%. RESULTS: Among 2905 patients who underwent AF ablation (age 62.9 ± 10.5 years; female 30.5%; persistent 43.6%, long-standing persistent 6.9%; primarily radiofrequency, cryoballoon 18.0%), within 2 years 38.0% had recurrence, and over average 6.1 ± 4.4-years follow-up 53.2% recurred. Multivariable predictors of recurrence (all p < 0.02) included recurrence during blanking period (HR 2.42, 95% CI 2.13-2.74), female sex (1.39, 1.22-1.59), each centimeter increase in LA size (1.34, 1.21-1.49), maximum regional LA fibrosis moderate (1.46, 1.25-1.71) or severe (1.42, 1.14-1.78), every year of AF duration (1.02, 1.00-1.03), and persistent (1.19, 1.03-1.37) or long-standing persistent AF (1.40, 1.10-1.78). Increasing quartiles of risk in the validation set had higher recurrences (compared to Q1; Q2 1.62, 1.19-2.19; Q3 2.58, 1.92-3.46; Q4 4.60, 3.46-6.11; all p < 0.0001). CONCLUSION: Over an average 6.1-year follow-up, over half of AF ablation patients had a recurrence of AF/AFL. Independent predictors of recurrence were early recurrence during 3-month blanking period, female sex, increased LA size, moderate/severe maximum regional LA fibrosis, longer AF duration, and non-paroxysmal AF. CONDENSED ABSTRACT: This observational single-center evaluation included 2905 consecutive AF first-time catheter ablation patients between 2008 and 2022 (age 62.9 ± 10.5 years; female 30.5%; persistent 43.6%, long-standing persistent 6.9%; mostly radiofrequency, cryoballoon 18.0%; follow-up 6.1 ± 4.4 years). A multivariable model developed in 70% data set predicted late (> 3 months) AF/flutter recurrences in remaining 30%. Predictors included recurrence during blanking period (HR 2.42, 95% CI 2.13-2.74), female sex (1.39, 1.22-1.59), each cm increase in LA size (1.34, 1.21-1.49), maximum regional LA fibrosis moderate (1.46, 1.25-1.71) or severe (1.42, 1.14-1.78), every year of AF duration (1.02, 1.00-1.03), and persistent (1.19, 1.03-1.37) or long-standing persistent AF (1.40, 1.10-1.78).