Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation
Background Atrial arrhythmia recurrence after atrial fibrillation (AF) catheter ablation is conventionally assessed as a binary end point. However, the prognostic value of recurrence patterns is less studied. Methods and Results This study included patients undergoing catheter ablation from the mult...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-05-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038832 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849734623826804736 |
|---|---|
| author | Sitong Li Jingrui Zhang Song Zuo Jue Wang Yiwei Lai Mingxiao Li Zejun Yang Zixu Zhao Manlin Zhao Lan Ren Zhen Wang Chao Jiang Liu He Xueyuan Guo Xiaoxia Liu Ribo Tang Ning Zhou Caihua Sang Deyong Long Xin Du Jianzeng Dong Changsheng Ma |
| author_facet | Sitong Li Jingrui Zhang Song Zuo Jue Wang Yiwei Lai Mingxiao Li Zejun Yang Zixu Zhao Manlin Zhao Lan Ren Zhen Wang Chao Jiang Liu He Xueyuan Guo Xiaoxia Liu Ribo Tang Ning Zhou Caihua Sang Deyong Long Xin Du Jianzeng Dong Changsheng Ma |
| author_sort | Sitong Li |
| collection | DOAJ |
| description | Background Atrial arrhythmia recurrence after atrial fibrillation (AF) catheter ablation is conventionally assessed as a binary end point. However, the prognostic value of recurrence patterns is less studied. Methods and Results This study included patients undergoing catheter ablation from the multicenter China Atrial Fibrillation Registry study (2011–2022). Postablation AF patterns within 1 year were categorized as nonrecurrence, paroxysmal AF recurrence, or persistent AF (PersAF) recurrence. Cardiovascular outcomes included cardiovascular death, thromboembolism, and cardiovascular hospitalization. Cox proportional models with landmark analysis were used to assess the relationship between recurrence patterns and outcomes. Sensitivity analyses were conducted using Fine‐Gray models, considering death unrelated to the outcomes as the competing risk and evaluating 2‐year recurrence patterns. Among 13 811 patients (mean age, 60.5±10.8 years; 66.1% men), those with preablation PersAF, prior stroke/transient ischemic attack/systemic embolism, and increased left atrial diameter were more likely to develop PersAF postablation. Compared with nonrecurrence, PersAF recurrence was associated with higher risks of cardiovascular death (hazard ratio [HR], 2.03 [95% CI, 1.20–3.43]; P=0.009), thromboembolism (HR, 1.50 [95% CI, 1.09–2.06]; P=0.012), and cardiovascular hospitalization (HR, 1.74 [95% CI, 1.56–1.94]; P<0.001) during a median follow‐up of 3.02 years (interquartile range, 1.44–5.03 years), while paroxysmal AF recurrence was only significantly associated with an increased risk of cardiovascular hospitalization (HR, 1.98 [95% CI, 1.83–2.14], P<0.001). Sensitivity analyses yielded consistent results. Conclusions Postablation PersAF recurrence was associated with significantly higher risks of cardiovascular death and thromboembolism, compared with paroxysmal AF recurrence and nonrecurrence, indicating the prognostic importance of recurrence patterns. Registration URL: www.chictr.org.cn/; unique identifier: ChiCTR‐OCH‐13003729. |
| format | Article |
| id | doaj-art-de1236aaa03741e4aa9900a4269d862e |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-de1236aaa03741e4aa9900a4269d862e2025-08-20T03:07:44ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-05-0114910.1161/JAHA.124.038832Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial FibrillationSitong Li0Jingrui Zhang1Song Zuo2Jue Wang3Yiwei Lai4Mingxiao Li5Zejun Yang6Zixu Zhao7Manlin Zhao8Lan Ren9Zhen Wang10Chao Jiang11Liu He12Xueyuan Guo13Xiaoxia Liu14Ribo Tang15Ning Zhou16Caihua Sang17Deyong Long18Xin Du19Jianzeng Dong20Changsheng Ma21Department of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaBackground Atrial arrhythmia recurrence after atrial fibrillation (AF) catheter ablation is conventionally assessed as a binary end point. However, the prognostic value of recurrence patterns is less studied. Methods and Results This study included patients undergoing catheter ablation from the multicenter China Atrial Fibrillation Registry study (2011–2022). Postablation AF patterns within 1 year were categorized as nonrecurrence, paroxysmal AF recurrence, or persistent AF (PersAF) recurrence. Cardiovascular outcomes included cardiovascular death, thromboembolism, and cardiovascular hospitalization. Cox proportional models with landmark analysis were used to assess the relationship between recurrence patterns and outcomes. Sensitivity analyses were conducted using Fine‐Gray models, considering death unrelated to the outcomes as the competing risk and evaluating 2‐year recurrence patterns. Among 13 811 patients (mean age, 60.5±10.8 years; 66.1% men), those with preablation PersAF, prior stroke/transient ischemic attack/systemic embolism, and increased left atrial diameter were more likely to develop PersAF postablation. Compared with nonrecurrence, PersAF recurrence was associated with higher risks of cardiovascular death (hazard ratio [HR], 2.03 [95% CI, 1.20–3.43]; P=0.009), thromboembolism (HR, 1.50 [95% CI, 1.09–2.06]; P=0.012), and cardiovascular hospitalization (HR, 1.74 [95% CI, 1.56–1.94]; P<0.001) during a median follow‐up of 3.02 years (interquartile range, 1.44–5.03 years), while paroxysmal AF recurrence was only significantly associated with an increased risk of cardiovascular hospitalization (HR, 1.98 [95% CI, 1.83–2.14], P<0.001). Sensitivity analyses yielded consistent results. Conclusions Postablation PersAF recurrence was associated with significantly higher risks of cardiovascular death and thromboembolism, compared with paroxysmal AF recurrence and nonrecurrence, indicating the prognostic importance of recurrence patterns. Registration URL: www.chictr.org.cn/; unique identifier: ChiCTR‐OCH‐13003729.https://www.ahajournals.org/doi/10.1161/JAHA.124.038832atrial fibrillationcardiovascular deathcatheter ablationpatterns of recurrencethromboembolism |
| spellingShingle | Sitong Li Jingrui Zhang Song Zuo Jue Wang Yiwei Lai Mingxiao Li Zejun Yang Zixu Zhao Manlin Zhao Lan Ren Zhen Wang Chao Jiang Liu He Xueyuan Guo Xiaoxia Liu Ribo Tang Ning Zhou Caihua Sang Deyong Long Xin Du Jianzeng Dong Changsheng Ma Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation cardiovascular death catheter ablation patterns of recurrence thromboembolism |
| title | Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation |
| title_full | Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation |
| title_fullStr | Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation |
| title_full_unstemmed | Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation |
| title_short | Patterns of Postablation Recurrence and Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation |
| title_sort | patterns of postablation recurrence and adverse cardiovascular outcomes in patients with atrial fibrillation |
| topic | atrial fibrillation cardiovascular death catheter ablation patterns of recurrence thromboembolism |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038832 |
| work_keys_str_mv | AT sitongli patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT jingruizhang patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT songzuo patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT juewang patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT yiweilai patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT mingxiaoli patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT zejunyang patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT zixuzhao patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT manlinzhao patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT lanren patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT zhenwang patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT chaojiang patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT liuhe patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT xueyuanguo patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT xiaoxialiu patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT ribotang patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT ningzhou patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT caihuasang patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT deyonglong patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT xindu patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT jianzengdong patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation AT changshengma patternsofpostablationrecurrenceandadversecardiovascularoutcomesinpatientswithatrialfibrillation |