Impact of acute atrial fibrillation termination and prolongation of atrial fibrillation cycle length on the outcome of ablation of persistent atrial fibrillation: A substudy of the STAR AF II trial

for the STAR AF II Investigators

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Abstract

Background: Controversy exists about the impact of acute atrial fibrillation (AF) termination and prolongation of atrial fibrillation cycle length (AFCL) during ablation on long-term procedural outcome. Objective: The purpose of this study was to analyze the influence of AF termination and AFCL prolongation on freedom from AF in patients from the STAR AF II (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial—Part II) trial. Methods: Acute changes in AFCL and AF termination were collected during the index procedure of the STAR AF II trial and compared to recurrence of AF at 18 months. Recurrence was assessed by ECG, Holter (3, 6, 9, 12, 18 months), and weekly transtelephonic ECG monitoring for 18 months. Results AF terminated in 8% of the pulmonary vein isolation (PVI) arm, 45% in the PVI+complex electrogram arm, and 22% of the PVI+linear ablation arm (P <.001), but freedom from AF did not differ among the 3 groups (P =.15). Freedom from AF was significantly higher in patients who presented to the laboratory in sinus rhythm (SR) compared to those without AF termination (63% vs 44%, P =.007). Patients with AF termination had an intermediate outcome (53%) that was not significantly different from those in SR (P =.84) or those who did not terminate (P =.08). AF termination was a univariable predictor of success (P =.007), but by multivariable analysis, presence of early SR was the strongest predictor of success (hazard ratio 0.67, P =.004). Prolongation of AFCL was not predictive of 18-month freedom from AF. Conclusion: Acute AF termination and prolongation in AFCL did not consistently predict 18-month freedom from AF. Presence of SR before or early during the ablation was the strongest predictor of better outcome.

Original languageEnglish
Pages (from-to)476-483
Number of pages8
JournalHeart Rhythm
Volume14
Issue number4
DOIs
Publication statusPublished - 1 Apr 2017

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Atrial Fibrillation
Pulmonary Veins
Electrocardiography
Recurrence

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@article{9367260ce28a41d0807f4fdc09aee419,
title = "Impact of acute atrial fibrillation termination and prolongation of atrial fibrillation cycle length on the outcome of ablation of persistent atrial fibrillation: A substudy of the STAR AF II trial",
abstract = "Background: Controversy exists about the impact of acute atrial fibrillation (AF) termination and prolongation of atrial fibrillation cycle length (AFCL) during ablation on long-term procedural outcome. Objective: The purpose of this study was to analyze the influence of AF termination and AFCL prolongation on freedom from AF in patients from the STAR AF II (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial—Part II) trial. Methods: Acute changes in AFCL and AF termination were collected during the index procedure of the STAR AF II trial and compared to recurrence of AF at 18 months. Recurrence was assessed by ECG, Holter (3, 6, 9, 12, 18 months), and weekly transtelephonic ECG monitoring for 18 months. Results AF terminated in 8{\%} of the pulmonary vein isolation (PVI) arm, 45{\%} in the PVI+complex electrogram arm, and 22{\%} of the PVI+linear ablation arm (P <.001), but freedom from AF did not differ among the 3 groups (P =.15). Freedom from AF was significantly higher in patients who presented to the laboratory in sinus rhythm (SR) compared to those without AF termination (63{\%} vs 44{\%}, P =.007). Patients with AF termination had an intermediate outcome (53{\%}) that was not significantly different from those in SR (P =.84) or those who did not terminate (P =.08). AF termination was a univariable predictor of success (P =.007), but by multivariable analysis, presence of early SR was the strongest predictor of success (hazard ratio 0.67, P =.004). Prolongation of AFCL was not predictive of 18-month freedom from AF. Conclusion: Acute AF termination and prolongation in AFCL did not consistently predict 18-month freedom from AF. Presence of SR before or early during the ablation was the strongest predictor of better outcome.",
keywords = "Ablation, Atrial fibrillation, Atrial fibrillation cycle length, Outcome, Termination",
author = "{for the STAR AF II Investigators} and Simon Kochh{\"a}user and Jiang, {Chen Yang} and Betts, {Timothy R.} and Jian Chen and Isabel Deisenhofer and Roberto Mantovan and Laurent Macle and Morillo, {Carlos A.} and Wilhelm Haverkamp and Rukshen Weerasooriya and Albenque, {Jean Paul} and Stefano Nardi and Endrj Menardi and Paul Novak and Prashanthan Sanders and Atul Verma",
year = "2017",
month = "4",
day = "1",
doi = "10.1016/j.hrthm.2016.12.033",
language = "English",
volume = "14",
pages = "476--483",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Impact of acute atrial fibrillation termination and prolongation of atrial fibrillation cycle length on the outcome of ablation of persistent atrial fibrillation

T2 - A substudy of the STAR AF II trial

AU - for the STAR AF II Investigators

AU - Kochhäuser, Simon

AU - Jiang, Chen Yang

AU - Betts, Timothy R.

AU - Chen, Jian

AU - Deisenhofer, Isabel

AU - Mantovan, Roberto

AU - Macle, Laurent

AU - Morillo, Carlos A.

AU - Haverkamp, Wilhelm

AU - Weerasooriya, Rukshen

AU - Albenque, Jean Paul

AU - Nardi, Stefano

AU - Menardi, Endrj

AU - Novak, Paul

AU - Sanders, Prashanthan

AU - Verma, Atul

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background: Controversy exists about the impact of acute atrial fibrillation (AF) termination and prolongation of atrial fibrillation cycle length (AFCL) during ablation on long-term procedural outcome. Objective: The purpose of this study was to analyze the influence of AF termination and AFCL prolongation on freedom from AF in patients from the STAR AF II (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial—Part II) trial. Methods: Acute changes in AFCL and AF termination were collected during the index procedure of the STAR AF II trial and compared to recurrence of AF at 18 months. Recurrence was assessed by ECG, Holter (3, 6, 9, 12, 18 months), and weekly transtelephonic ECG monitoring for 18 months. Results AF terminated in 8% of the pulmonary vein isolation (PVI) arm, 45% in the PVI+complex electrogram arm, and 22% of the PVI+linear ablation arm (P <.001), but freedom from AF did not differ among the 3 groups (P =.15). Freedom from AF was significantly higher in patients who presented to the laboratory in sinus rhythm (SR) compared to those without AF termination (63% vs 44%, P =.007). Patients with AF termination had an intermediate outcome (53%) that was not significantly different from those in SR (P =.84) or those who did not terminate (P =.08). AF termination was a univariable predictor of success (P =.007), but by multivariable analysis, presence of early SR was the strongest predictor of success (hazard ratio 0.67, P =.004). Prolongation of AFCL was not predictive of 18-month freedom from AF. Conclusion: Acute AF termination and prolongation in AFCL did not consistently predict 18-month freedom from AF. Presence of SR before or early during the ablation was the strongest predictor of better outcome.

AB - Background: Controversy exists about the impact of acute atrial fibrillation (AF) termination and prolongation of atrial fibrillation cycle length (AFCL) during ablation on long-term procedural outcome. Objective: The purpose of this study was to analyze the influence of AF termination and AFCL prolongation on freedom from AF in patients from the STAR AF II (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial—Part II) trial. Methods: Acute changes in AFCL and AF termination were collected during the index procedure of the STAR AF II trial and compared to recurrence of AF at 18 months. Recurrence was assessed by ECG, Holter (3, 6, 9, 12, 18 months), and weekly transtelephonic ECG monitoring for 18 months. Results AF terminated in 8% of the pulmonary vein isolation (PVI) arm, 45% in the PVI+complex electrogram arm, and 22% of the PVI+linear ablation arm (P <.001), but freedom from AF did not differ among the 3 groups (P =.15). Freedom from AF was significantly higher in patients who presented to the laboratory in sinus rhythm (SR) compared to those without AF termination (63% vs 44%, P =.007). Patients with AF termination had an intermediate outcome (53%) that was not significantly different from those in SR (P =.84) or those who did not terminate (P =.08). AF termination was a univariable predictor of success (P =.007), but by multivariable analysis, presence of early SR was the strongest predictor of success (hazard ratio 0.67, P =.004). Prolongation of AFCL was not predictive of 18-month freedom from AF. Conclusion: Acute AF termination and prolongation in AFCL did not consistently predict 18-month freedom from AF. Presence of SR before or early during the ablation was the strongest predictor of better outcome.

KW - Ablation

KW - Atrial fibrillation

KW - Atrial fibrillation cycle length

KW - Outcome

KW - Termination

UR - http://www.scopus.com/inward/record.url?scp=85014191643&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2016.12.033

DO - 10.1016/j.hrthm.2016.12.033

M3 - Article

VL - 14

SP - 476

EP - 483

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 4

ER -