The Southern Brazilian Registry of Atrial Fibrillation (SBR-AF Registry): Predictors of Atrial Arrhythmia Recurrence after First-Time Catheter Ablation.

Arquivos brasileiros de cardiologia Pub Date : 2025-01-27 eCollection Date: 2025-01-01 DOI:10.36660/abc.20240246
Caique M P Ternes, Luis E Rohde, Alexander Dal Forno, Andrei Lewandowski, Helcio Garcia Nascimento, Gabriel Odozynski, Claudio Ferreira, Enrico G Ferro, Carisi A Polanczyk, André Zimerman, Lucas S Faganello, Eric Pasqualotto, Grazyelle Damasceno, Leandro I Zimerman, Andre d'Avila
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Abstract

Background: Treatment of atrial fibrillation (AF) with catheter ablation (CA) has evolved significantly. However, real-world data on long-term outcomes are limited, particularly in low- and middle-income countries.

Objective: This multicenter prospective cohort of consecutive patients aimed to evaluate the safety and efficacy of first-time CA for AF in Southern Brazil from 2009 to 2024.

Methods: The primary outcome was any atrial tachyarrhythmia (ATA) recurrence. Multivariable Cox proportional hazards model assessed independent predictors of recurrence.

Results: Among 1,043 patients (mean age 67.3 ± 11.3 years, 27.9% female), 75.5% had paroxysmal AF. At a median follow-up of 1.4 (1.0 - 3.4) years, 21.4% had ATA recurrence. Recurrence rates were 18.6% for paroxysmal and 29.8% for persistent AF, and 67.3% of events occurred within the first year after CA. Predictors of recurrence were persistent AF at baseline (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.15-2.13; p = 0.004), enlargement of left atrial diameter (HR 1.03, 95% CI 1.00-1.05; p = 0.033), and higher EHRA score of AF symptoms (HR 1.60, 95% CI 1.18-2.18; p = 0.003). Recurrence rates decreased over time according to the procedure's calendar year, with a 9% relative reduction per consecutive year (HR 0.91; p < 0.001). There was a 2.1% rate of procedure-related adverse events.

Conclusions: In the largest cohort study of consecutive AF ablations in Latin America, predictors of ATA recurrence were related to later stages of AF. Complication and recurrence rates were comparable to those in high-income countries, underscoring the global applicability of CA for AF management.

巴西南部心房颤动登记(SBR-AF登记):首次导管消融后心房心律失常复发的预测因素。
背景:导管消融(CA)治疗心房颤动(AF)已经有了显著的进展。然而,关于长期结果的实际数据有限,特别是在低收入和中等收入国家。目的:本多中心前瞻性队列研究旨在评估2009年至2024年巴西南部首次CA治疗房颤的安全性和有效性。方法:主要结局为房性心动过速(ATA)复发。多变量Cox比例风险模型评估复发的独立预测因子。结果:1043例患者(平均年龄67.3±11.3岁,女性27.9%)中,75.5%为阵发性房颤。中位随访1.4(1.0 - 3.4)年,21.4%的患者ATA复发。发作性AF的复发率为18.6%,持续性AF的复发率为29.8%,67.3%的事件发生在CA后的一年内。复发的预测因子为基线时的持续性AF(风险比[HR] 1.57, 95%可信区间[CI] 1.15-2.13;p = 0.004),左房内径增大(HR 1.03, 95% CI 1.00-1.05;p = 0.033),房颤症状的EHRA评分较高(HR 1.60, 95% CI 1.18-2.18;P = 0.003)。复发率随手术日历年的推移而下降,每连续一年相对降低9% (HR 0.91;P < 0.001)。手术相关不良事件发生率为2.1%。结论:在拉丁美洲最大的连续房颤消融队列研究中,房颤复发的预测因素与房颤晚期有关。并发症和复发率与高收入国家相当,强调房颤治疗在全球的适用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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