Predictors of AF Recurrence After Radiofrequency Catheter Ablation
Predictors of AF Recurrence After Radiofrequency Catheter Ablation
AF Recurrence After RFA: Systematic Review.
Introduction: The relationship between success of radiofrequency ablation for atrial fibrillation (AF) and patient characteristics has not been systematically evaluated.
Methods and Results: We searched MEDLINE and Cochrane Central Trials Registry databases from 2000 through 2008 for studies reporting preprocedure predictors and AF recurrence after radiofrequency ablation. We extracted multivariable analyses and univariable data on predictors and AF recurrence. Eligible studies were highly heterogeneous, particularly regarding ablation technique and definition of AF recurrence. Among 25 studies with multivariable analyses, two-thirds to 90% of studies found that AF type, ejection fraction, left atrial diameter, structural heart disease, hypertension, and AF symptom duration did not predict AF recurrence (among patients with ejection fraction above 40% and left atrial diameter below about 55 mm). Studies found that gender and age were not predictors (in patients between 40 and 70 years old). Meta-analyses of univariable AF recurrence rates by AF type in 31 studies found that studies were statistically heterogeneous, but that nonparoxysmal AF predicted AF recurrence compared to paroxysmal AF (relative risk 1.59; 95% confidence interval 1.38–1.82; P < 0.001); meta-analyses of persistent or permanent versus paroxysmal AF yielded similar findings.
Conclusion: Nonparoxysmal AF may be a clinically useful proxy for a combination of confounded variables, none of which alone is an independent predictor of AF recurrence. Evaluation of predictors was limited by exclusion of patients with severe heart disease or at the age extremes; thus, the evidence may not be as applicable to these populations.
For patients with atrial fibrillation (AF) refractory to antiarrhythmic drugs, radiofrequency ablation (RFA) is an increasingly utilized treatment option. Determinants of RFA success, or freedom from arrhythmia, depend on patient factors as well as the technical aspects of the procedure. Rates of success for maintaining sinus rhythm have varied widely, ranging from less than 30% to 85%. The relationship between RFA success and patient characteristics has not been systematically evaluated. The patient population in which AF occurs is heterogeneous with respect to duration and type of AF, age, gender, presence of structural heart disease, comorbidities such as hypertension, diabetes mellitus, congestive heart failure, and history of embolic events. Identifying predictors of success in maintaining sinus rhythm after RFA may help improve patient selection for this procedure to reduce health care costs and avoid exposing patients to unnecessary procedures and related complications. While there is consensus that death, stroke, symptoms, and quality of life are more relevant outcomes than rhythm control, to date, data on predictors of these outcomes remain sparse. The aim of this systematic review is to summarize the evidence regarding the preprocedure patient characteristics that are associated with AF recurrence after RFA.
Abstract and Introduction
Abstract
AF Recurrence After RFA: Systematic Review.
Introduction: The relationship between success of radiofrequency ablation for atrial fibrillation (AF) and patient characteristics has not been systematically evaluated.
Methods and Results: We searched MEDLINE and Cochrane Central Trials Registry databases from 2000 through 2008 for studies reporting preprocedure predictors and AF recurrence after radiofrequency ablation. We extracted multivariable analyses and univariable data on predictors and AF recurrence. Eligible studies were highly heterogeneous, particularly regarding ablation technique and definition of AF recurrence. Among 25 studies with multivariable analyses, two-thirds to 90% of studies found that AF type, ejection fraction, left atrial diameter, structural heart disease, hypertension, and AF symptom duration did not predict AF recurrence (among patients with ejection fraction above 40% and left atrial diameter below about 55 mm). Studies found that gender and age were not predictors (in patients between 40 and 70 years old). Meta-analyses of univariable AF recurrence rates by AF type in 31 studies found that studies were statistically heterogeneous, but that nonparoxysmal AF predicted AF recurrence compared to paroxysmal AF (relative risk 1.59; 95% confidence interval 1.38–1.82; P < 0.001); meta-analyses of persistent or permanent versus paroxysmal AF yielded similar findings.
Conclusion: Nonparoxysmal AF may be a clinically useful proxy for a combination of confounded variables, none of which alone is an independent predictor of AF recurrence. Evaluation of predictors was limited by exclusion of patients with severe heart disease or at the age extremes; thus, the evidence may not be as applicable to these populations.
Introduction
For patients with atrial fibrillation (AF) refractory to antiarrhythmic drugs, radiofrequency ablation (RFA) is an increasingly utilized treatment option. Determinants of RFA success, or freedom from arrhythmia, depend on patient factors as well as the technical aspects of the procedure. Rates of success for maintaining sinus rhythm have varied widely, ranging from less than 30% to 85%. The relationship between RFA success and patient characteristics has not been systematically evaluated. The patient population in which AF occurs is heterogeneous with respect to duration and type of AF, age, gender, presence of structural heart disease, comorbidities such as hypertension, diabetes mellitus, congestive heart failure, and history of embolic events. Identifying predictors of success in maintaining sinus rhythm after RFA may help improve patient selection for this procedure to reduce health care costs and avoid exposing patients to unnecessary procedures and related complications. While there is consensus that death, stroke, symptoms, and quality of life are more relevant outcomes than rhythm control, to date, data on predictors of these outcomes remain sparse. The aim of this systematic review is to summarize the evidence regarding the preprocedure patient characteristics that are associated with AF recurrence after RFA.
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