The Correlation Between Persistent Atrial Fibrillation Termination By Ablation And The Type Of Atrial Fibrillation Recurrence

Background:The guidelines have defined AF recurrence as the recurrence of Atrial Fibrillation（AF）,Atrial Tachycardia（AT）or Atrial Flutter（AFL）lasting longer than30 seconds.The mechanism of recurrence as AT and AFL after AF ablation are similar,and AFL formed by large reentrant mechanism can be attributed to AT.Compared with paroxysmal AF,the AF recurrence rate was high after ablation in patients with Persistent AF（PAF）.And most patients needed a second ablation to maintain Sinus Rhythm（SR）.The recurrence mechanism of AT and AF was not completely same.Most of recurrence as AT/AFL after AF ablation was due to reentrant mechanism.The reentrant loop could be clearly mapped during ablation,and achieved a high success rate of ablation.However,the mechanism of recurrence as AF was still complicated in patients with PAF,and there was still no clear ablation strategy,so the success rate was difficult to estimate.Therefore,the type of atrial arrhythmia recurrence after AF ablation directly affects the ablation strategy and success rate of the second ablation.The objective of our study was to observe whether AF termination by ablation（directly to SR or via intermediate AT to SR）affected the type of late AF recurrence.Methods:A total of 345 patients with PAF who continuous underwent catheter ablation in the Second Affiliated Hospital of Nanchang University from January 2018 to January2022 were selected as the study objects.Among them,16 patients were excluded due to lack of follow-up data,and 329 patients were finally included.According to whether AF termination by ablation,patients were divided into two groups（AF termination group and AF non-termination group）.The general information[including age,gender,body mass index,CHA₂DS₂-VASC score,HAS-BLED score,left atrial diameter,left ventricular ejection fraction,smoking,drinking,complications（hypertension,diabetes,stroke,coronary heart disease）,and ablation indicators（ablation energy,ablation temperature,operation time,fluoroscopy time and ablation time）].All patients were followed up for 12 months after ablation.For the meta-analysis,the online databases including Pub Med,EMBASE,Web of Science,Cochrane Library,and China National Knowledge Infrastructure were comprehensi-vely searched from inception until January 2022.Two researchers independently searched and screened the literature,extracted data and evaluated their quality.The Newcastle-Ottawa scale score was used to assess the quality of the included studies.And the heterogeneity among studies was quantified using the Cochran’s Q and I²statistics,so the fixed effects model and inverse variance heterogeneity model was selected.Statistical analysis was performed by Review Manager 5.3,STATA 12.0 and Meta XL 5.3 software.Results:Of the 329 enrolled patients in our center,106（32%）achieved AF termination by ablation and 223 patients（68%）did not.After 12 months of follow-up,we found a total of 29 patients（29/106）with AF recurrence in AF termination by ablation group,of them 24 patients（24/29）recurrence as AT/AFL and 5 patients（5/29）recurrence as AF;For AF non-termination by ablation group,a total of 72 patients（72/223）with AF recurrence,of them 30 patients（30/72）recurrence as AT/AFL and 42 patients（42/72）recurrence as AF.AF termination by ablation was associated with the increased probability of recurrence as AT/AFL（24/29 versus 30/72,P<0.001）in PAF patients compared with AF non-termination.Including our center and a total of 11eligible studies comprising 962 patients with AF recurrence（419 in AF termination group versus 543 in AF non-termination group）were included in the meta-analysis.The meta-analysis demonstrated that compared with AF non-termination,AF termination by ablation was also associated with the increased probability of recurrence as AT/AFL（RR,1.44;95%CI,1.15 to 1.80）in PAF patients.Conclusion:Our study demonstrated that AF termination by ablation could affect AF recurrence type in PAF patients.Compared with AF non-termination,AF termination by ablation was associated with the increased probability of recurrence as AT/AFL in PAF patients.