Association Of Nifekalant Cardioversion Failure During Catheter Ablation Procedure And Atrial Fibrillation Recurrence

Part 1Objective: To investigate the association between nifekalant cardioversion failure and early recurrence of persistent atrial fibrillation(AF)post-ablation.Methods: This was a single-center retrospective study.Patients with drug-refractory persistent AF were consecutively enrolled from the Xijing Hospital between November2020 and January 2022.Patients were assigned to the success group and failure group based on nifekalant cardioversion results.Patients were assessed for early recurrence within 3months post-ablation.Results: Among 611 patients,a total of 92 patients with persistent AF were enrolled.Each group included 46 patients.Age ≥ 65 years,AF duration,as well as late AF,and diabetes were strongly associated with failure of intravenous nifekalant cardioversion.Univariable and multivariable analyses suggested that failure of nifekalant cardioversion did not increase the risk of early recurrence.Nifekalant cardioversion failure is not an important for explainable machine learning model.Conclusion: Early recurrence rate in nifekalant cardioversion failure group was numerically higher than success group,but did not have statistical significance.The association of nifekalant cardioversion failure and early recurrence could not be confirmed.part 2Objective: To investigate the association between nifekalant cardioversion failure and longterm recurrence of persistent atrial fibrillation(AF)post-ablation.Methods: This was a single-center retrospective study.Patients with drug-refractory persistent AF were consecutively enrolled from the Xijing Hospital between November2020 and January 2022.Patients were assigned to the success group and failure group based on nifekalant cardioversion results and followed for 12 months to explore any episode of atrial tachy-arrhythmia recurrence.Results: After 12 months of follow-up,nine(19.6%)patients from success group and 23(50.0%)patients from failure group had a long-term recurrence(P = 0.002).Univariable Cox proportional hazard regression showed that failure of intravenous nifekalant cardioversion was a potential risk factor for long-term recurrence.Multivariable Cox proportional hazard regression showed that failure of nifekalant cardioversion was statistically associated with long-term recurrence.Failure of intravenous nifekalant cardioversion could bring a positive effect on the prognostic differentiation when added into the multivariable model.Conclusions: Failure of nifekalant cardioversion is an independent predictor for persistent atrial fibrillation long-term recurrence after catheter ablation.part 3Objective: To explore the association between nifekalant cardioversion failure and recurrence of paroxysmal atrial fibrillation(AF)post-ablation.Methods: This was a single-center retrospective study.Patients with drug-refractory persistent AF were consecutively enrolled from the Xijing Hospital between November2020 and January 2022.Patients were assigned to the success group and failure group based on nifekalant cardioversion results.Patients were assessed for early recurrence within 3months post-ablation and followed for 12 months to explore any episode of atrial tachyarrhythmia recurrence.Results: Among 611 patients,a total of 30 patients were enrolled in the present study: 19 patients in success group,and 11 patients in failure group.Failure of nifekalant cardioversion did not increase the rate of early recurrence,but significantly increased the incidence of long-term recurrence.The risk of long-term recurrence was similar in nifekalant cardioversion failure patients,whether paroxysmal or persistent AF.Conclusions: In paroxysmal atrial fibrillation cohort,compared with successful nifekalant cardioversion patients,failed cardioversion patients have a higher post-procedural longterm recurrence risk.Larger-scale studies are needed to further confirm our results.