Sanjeev Saksena, Jennifer Ken-Opurum, David S McKindley, Ron Preblick, Jason Rashkin, Omar M Aldaas, Sesha Sai Srinivas Sistla, Jonathan C Hsu
{"title":"Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation (ARRC-AF Study).","authors":"Sanjeev Saksena, Jennifer Ken-Opurum, David S McKindley, Ron Preblick, Jason Rashkin, Omar M Aldaas, Sesha Sai Srinivas Sistla, Jonathan C Hsu","doi":"10.1016/j.jacep.2024.11.020","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Rhythm control in atrial fibrillation (AF) can be achieved with catheter ablation, but arrhythmia recurrences can require further interventions.</p><p><strong>Objectives: </strong>The aim of this study was to characterize rhythm-control strategies after index ablation.</p><p><strong>Methods: </strong>A total of 2,429,863 patients in Optum's deidentified Market Clarity Data who underwent index ablation for newly diagnosed AF (2007-2021) were followed until disenrollment, death, or study end. Repeat ablations; AF, atrial flutter, or other tachycardias following index ablation; and antiarrhythmic drug (AAD) practices after ablation were examined.</p><p><strong>Results: </strong>In total, 23,323 patients underwent index ablation (median follow-up duration 1,165 days); 3,862 (16.6%) underwent ≥2 ablations (2 ablations, 14.2%; 3 ablations, 2.0%; ≥4 ablations, 0.4%). In patients with repeat ablations, incident individual AF or atrial flutter patient events (n = 7,907) averaged 2.0 per patient, while other coded arrhythmias (n = 2,298) averaged 0.6 per patient. AAD use after index ablation was common (46.9% overall), ranging from 62.8% to 92.3% among patients with ≥1 repeat ablation. Repeat ablation was associated with AF phenotype (long-standing persistent vs paroxysmal; incidence rate ratio [IRR]: 2.26; 95% CI: 1.27-3.68), AAD use (vs no use; IRR: 1.42; 95% CI: 1.30-1.56), obstructive sleep apnea (vs no obstructive sleep apnea; IRR: 1.26; 95% CI: 1.20-1.33), valvular heart disease (vs no valvular heart disease; IRR: 1.12; 95% CI: 1.07-1.18), coronary artery disease (vs no coronary artery disease; IRR: 1.13; 95% CI: 1.07-1.19), and body mass index 30 to 35 kg/m<sup>2</sup> (vs <30 kg/m<sup>2</sup>; IRR: 1.10; 95% CI: 1.02-1.20).</p><p><strong>Conclusions: </strong>In this study, additional rhythm-control strategies were frequently continued after index ablation. One in 6 patients underwent repeat ablation, with the majority receiving concomitant AAD therapy. These data indicate that a combined strategy of catheter ablation and AADs is currently used in practice for rhythm control.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0000,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Clinical electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jacep.2024.11.020","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Rhythm control in atrial fibrillation (AF) can be achieved with catheter ablation, but arrhythmia recurrences can require further interventions.
Objectives: The aim of this study was to characterize rhythm-control strategies after index ablation.
Methods: A total of 2,429,863 patients in Optum's deidentified Market Clarity Data who underwent index ablation for newly diagnosed AF (2007-2021) were followed until disenrollment, death, or study end. Repeat ablations; AF, atrial flutter, or other tachycardias following index ablation; and antiarrhythmic drug (AAD) practices after ablation were examined.
Results: In total, 23,323 patients underwent index ablation (median follow-up duration 1,165 days); 3,862 (16.6%) underwent ≥2 ablations (2 ablations, 14.2%; 3 ablations, 2.0%; ≥4 ablations, 0.4%). In patients with repeat ablations, incident individual AF or atrial flutter patient events (n = 7,907) averaged 2.0 per patient, while other coded arrhythmias (n = 2,298) averaged 0.6 per patient. AAD use after index ablation was common (46.9% overall), ranging from 62.8% to 92.3% among patients with ≥1 repeat ablation. Repeat ablation was associated with AF phenotype (long-standing persistent vs paroxysmal; incidence rate ratio [IRR]: 2.26; 95% CI: 1.27-3.68), AAD use (vs no use; IRR: 1.42; 95% CI: 1.30-1.56), obstructive sleep apnea (vs no obstructive sleep apnea; IRR: 1.26; 95% CI: 1.20-1.33), valvular heart disease (vs no valvular heart disease; IRR: 1.12; 95% CI: 1.07-1.18), coronary artery disease (vs no coronary artery disease; IRR: 1.13; 95% CI: 1.07-1.19), and body mass index 30 to 35 kg/m2 (vs <30 kg/m2; IRR: 1.10; 95% CI: 1.02-1.20).
Conclusions: In this study, additional rhythm-control strategies were frequently continued after index ablation. One in 6 patients underwent repeat ablation, with the majority receiving concomitant AAD therapy. These data indicate that a combined strategy of catheter ablation and AADs is currently used in practice for rhythm control.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
