Predictors for Late Recurrence of Atrial Fibrillation after Radiofrequency Catheter Ablation: Over 500 Cases Experience

Background: Although radiofrequency Catheter ablation (RFCA) for atrial fibrillation (AF) is an effective rhythm control strategy, there is a substantial recurrence rate. We explored predictors of late recurrence (LR) of AF after RFCA with consistent strategy. Methods and Results: This study included 575 patients (77.1% male, 55.7 ±10.9 years old) with AF (65.7% paroxysmal AF) who underwent RFCA. We evaluated the clinical, electrophysiological, and multiple serologic parameters. Results: 1. During 12.4±5.9 months of follow-up, patients who experienced LR (21.8%) were older (55.0 ±10.9 vs. 57.7 ± 10.1 years old, p=0.019) and more likely to have persistent AF (50.4% vs. 29.4%, p<0.001) and greater LA volume (137.3±49.1 vs. 116.6±37.9 mL, p<0.001). 2. In patients with LR, both ablation time (6607±2631 vs. 5536±2344 sec, p<0.001) and procedure time (243±80 vs. 206±59 min, p<0.001) were prolonged, and early recurrence rate within 3 month of procedure was higher (63.0% vs. 26.4%, p<0.001). 3. In binary logistic regression analysis, LA volume (OR 1.008, CI 1.001-1.014, p=0.018), ablation time>5400 sec (OR 2.169, CI 1.170-4.022, p=0.014), and early recurrence (OR 3.870, CI 2.371-6.319, p<0.001) were the independent risk factors for LR of AF. Conclusion: In this single consistent strategy with over 500 AF ablation cases, the patients with LR had larger atrium, longer ablation time, and higher chance of early recurrence than those remained in sinus rhythm.