Follow-up and effectiveness
Patients were monitored after the first repeat ablation for a median of
2.0 (1.0-3.3) years. During follow-up 142 (52.8%) patients with durably
isolated PVs had a recurrence of atrial arrhythmia >90 days
post-procedure and 30 (12.7%) patients underwent subsequent repeat
ablation within 12-months of the first repeat procedure (Table 2). At
last known follow-up moment, 141 (57.3%) patients were still using
anti-arrhythmic drugs.
The multivariable Cox proportional hazards model, conducted following
multivariable adjustment for age, sex, body-mass index, paroxysmal AF,
diabetes, CAD, and hypertension, identified no individual ablation
strategy as an independent predictor of AF recurrence (p >
0.05 for all; Figure 4). Subgroup analysis accounting for type of AF
(paroxysmal AF or persistent AF), similarly demonstrated no discernible
difference in AF recurrence for individual strategies between the two
groups [HR 1.001 (95% CI 0.67-1.51)]. Furthermore, no significant
associations were observed between the number of ablation strategies
adopted and AF recurrence rates, when compared to no additional ablation
(p>0.05; Figure 5). Sensitivity analyses confirmed the
stability of these findings, reinforcing the conclusion that neither the
choice of ablation strategy nor the cumulative number of strategies
employed significantly influenced the recurrence of AF post-PVI.
In the multivariate Cox regression model, left atrial size appeared to
be the only independent factor associated with an increased risk of
atrial arrhythmia recurrence [adjusted HR 1.03 (95% CI 1.01-1.05);
Figure 6].