Elsevier

The American Journal of Cardiology

Volume 133, 15 October 2020, Pages 71-76
The American Journal of Cardiology

New Predictor of Very Late Recurrence After Catheter Ablation of Atrial Fibrillation Using Holter Electrocardiogram Parameters

https://doi.org/10.1016/j.amjcard.2020.07.047Get rights and content

Highlights

  • Holter ECG was useful to predict the recurrence of AF after catheter ablation.

  • Small prematurity index of APCs has a great significance.

  • APCs burden may be associated with VLRAF.

This study aimed to evaluate the predictors of very late recurrence of atrial fibrillation (VLRAF) after an initial AF catheter ablation (CA) by analyzing the follow-up Holter electrocardiogram. We retrospectively studied patients (n = 253, mean age: 66 years, woman: 30%, paroxysmal AF: 73%) without recurrence of AF within 12 months and the use of antiarrhythmic drugs. In the Holter electrocardiogram analysis, the atrial premature complexes (APCs) burden, the profile of the APCs run and prematurity index of the APCs were evaluated. Fifty-one patients (20%) had VLRAF during the follow-up period (mean follow up: 46 months). Patients with VLRAF had a significantly greater APCs burden (0.318% [0.084 to 1.405] vs 0.132% [0.051 to 0.461], p = 0.022), longer number of APCs run (5 [3 to 11] vs 4 [0 to 7], p = 0.019), and shorter minimum prematurity index of the APCs (47 ± 7 vs 51 ± 6, p = 0.001) than those without VLRAF. The optimal cutoff value for the APCs burden, maximum number of APCs run, and minimum prematurity index of the APCs to predict VLRAF was 0.159%, 10, and 48%, respectively. The minimum prematurity index of the APCs (≤48%) was significantly associated with VLRAF in the multivariate analysis. In conclusion, the minimum prematurity index of the APCs (≤48%) at 12 months after CA was shown to be an independent predictor of VLRAF in patients without antiarrhythmic drugs. Although the index is a very simple parameter automatically calculated by analysis software, it can be an important index for following patients after CA over the long-term.

Section snippets

Methods

We retrospectively studied consecutive symptomatic AF patients who underwent a first CA between January 2011 and Mach 2017 and underwent 24-hour Holter ECGs 12 months after the CA. The exclusion criteria for this study were patients in need of antiarrhythmic drugs more than 3 months after the CA and those with recurrence of AF or atrial tachycardia within 12 months except for during the blanking period (3 months). All patients underwent CA at Osaka Rosai Hospital, according to the current

Results

Of 484 consecutive patients, 231 patients were excluded from this study due to a lost follow up, relapsed AF and requiring antiarrhythmic drugs. We retrospectively studied 253 consecutive symptomatic AF patients (age 66 ± 9 years, woman: 30%, paroxysmal AF: 73%). During a mean follow up duration of 46 ± 18 months, VLRAF occurred in 51 patients (20%) (VLRAF group). In 51 relapsed AF episodes, 90% had an AF burden >6 minutes, 70% had an AF burden >6 hours, and 40% had an AF burden ≥24 hours. The

Discussion

This study has elucidated the predictors of VLRAF in patients without antiarrhythmic drugs after the initial CA, using the parameters automatically calculated by the analysis software of the 24-hour Holter ECG. The main findings of this study were as follows: (1) ERAF, APCs burden of ≥0.159%, and minimum prematurity index of the APCs of ≤48% were associated with VLRAF; (2) in particular, a prematurity index of the APCs of ≤48% was an independent risk factor for VLRAF.

Yamane et al8 investigated

Author Contributions

All authors substantially contributed to the work and met the authorship criteria as follows:

Conception and design or analysis and interpretation of the data: Yasuyuki Egami, Kohei Ukita, Akito Kawamura, Hitoshi Nakamura, Yutaka Matsuhiro and Koji Yasumoto. Drafting of the manuscript or revising it critically for its important intellectual content: Masaki Tsuda, Naotaka Okamoto, Akihiro Tanaka, Yasuharu Matsunaga-Lee, Masamichi Yano and Ryu Shutta. Final approval of the manuscript submitted:

Disclosures

The authors have no conflicts of interest to disclose.

Acknowledgment

The authors thank Mr. John Martin for his linguistic assistance with this manuscript.

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