Hybrid Atrial Fibrillation Ablation: Association of Clinical Characteristics, Biomarkers, and Blanking Period with Recurrence.

Objectives: Hybrid atrial fibrillation (AF) ablation is a treatment for therapy-resistant, symptomatic AF. Limited data exist on the risk factors for failure of the procedure. Therefore, this study aimed to identify clinical factors and blood biomarkers associated with atrial arrhythmia recurrence within 2 years following hybrid ablation.

Methods: The hybrid AF ablation study is a single-centre, prospective, observational study including consecutive AF patients who underwent hybrid ablation between January 2015 and September 2021. Blood samples were collected pre-ablation, and 7 biomarkers were assessed based on their possible association with recurrence. The blanking period was defined as the first 3 months after ablation. Clinical follow-up visits combined with 12-lead electrocardiogram (ECG) and 72-hour Holter monitoring were scheduled at 3, 6, 12, and 24 months post-procedure. Cox proportional hazard regression analyses were performed to assess the association with recurrence.

Results: Of the 91 patients included (mean age 57.1 years [standard deviation: 8.1]; 16% women), 31 (34%) experienced atrial arrhythmia recurrence within 2 years following hybrid ablation, with a median time to recurrence of 254 days (interquartile range 147-428). Multivariable Cox proportional hazard regression, adjusted for age and sex, showed that recurrence in the blanking period was associated with atrial arrhythmia recurrence within 2 years post-ablation (hazard ratio 4.05, 95% confidence interval 1.85-8.91); however, no association was detected between other clinical factors or blood biomarkers and atrial arrhythmia recurrence.

Conclusions: In AF patients undergoing hybrid ablation, recurrence in the blanking period was associated with atrial arrhythmia recurrence within 2 years post-ablation.

Clinical registration: ClinicalTrials.gov, NCT02516033, https://clinicaltrials.gov/ct2/show/NCT02516033.