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The impact of basic atrial rhythm during catheter ablation of atrial fibrillation on clinical outcomes: Lessons from the German Ablation Registry.

BACKGROUND: The impact of basic atrial rhythm (sinus rhythm (SR) vs atrial fibrillation (AF)) during AF ablation on efficacy and safety is unknown.

METHODS: 3375 patients from the German Ablation Registry undergoing first-time AF ablation were divided according to the type of AF and the basic atrial rhythm during the ablation procedure: paroxysmal AF (PAF) and SR [group Ia], PAF and AF [group Ib]), persistent AF and SR (IIa) and persistent AF and AF (IIb).

RESULTS: Patients in SR (n=2312 (67%)) underwent cryoballoon ablation more often (Ia vs Ib p=0.002 and IIa vs IIb p=0.010, whereas in patients in AF (n=1063 (33%)) radiofrequency (RF)-based ablation (Ia vs Ib p=0.006 and IIa vs IIb p=0.014) including left and/or right atrial substrate modification was more frequently performed. Depending on the basic rhythm there was no difference regarding arrhythmia recurrence during long-term follow-up. For patients suffering from persistent AF acute procedure-related complications were more often documented when ablated in AF (9.1% vs. 4.6%, p=0.012). which was mainly driven by the higher occurrence of pericardial effusion/tamponade. For patients suffering from persistent AF, favourable results were found regarding 366-day Kaplan-Meier estimates of the incidence of MACCE (death, myocardial infarction and stroke; p=0.011) and the composite endpoint of death, myocardial infarction, stroke and major bleeding (p=0.006), when ablated in SR.

CONCLUSION: Basic atrial rhythm at the time of AF ablation did not affect long-term rhythm outcome. For patients suffering from persistent AF a more favorable acute and long-term safety profile was observed when ablated in SR. This article is protected by copyright. All rights reserved.

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