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Background Catheter ablation can improve long-term prognosis of patients with atrial fibrillation with systolic impairment. However, atrial tachyarrhythmia (ATA) recurrence increases during long-term follow-up. We aimed to investigate the impact of ATA recurrence on the development of long-term adverse clinical events following catheter ablation for atrial fibrillation and to identify predictors for the development of adverse clinical events. Methods and Results This single-center observational study included 75 patients with systolic impairment (left ventricular ejection fraction <50%) who underwent the first catheter ablation procedure for atrial fibrillation at our institution (median follow-up period: 3.5 [range: 2.4-4.7] years). We compared the cumulative incidence of adverse clinical events (all-cause death, heart failure hospitalization, stroke, or acute myocardial infarction) between the groups with and without ATA recurrence following the first and last procedures. Multivariable analyses were performed to identify predictors for developing adverse clinical events. Twenty-one patients (28%) developed adverse clinical events at a median of 2.2 (range: 0.64-2.8) years following the first procedure. The proportion of freedom from adverse clinical events following the first procedure was significantly lower in the ATA recurrence group than in the nonrecurrence group (41% [n=40] versus 95% [n=35], <0.0005); the proportion following the last procedure also showed a similar tendency (35% [n=26] versus 57% [n=49], <0.0001). ATA recurrence emerged as an independent predictor for adverse clinical events following both procedures after multivariable adjustment. Conclusions ATA recurrence following catheter ablation procedure could predict adverse clinical events in patients with atrial fibrillation with systolic impairment.

背景

导管消融术可改善收缩功能障碍的心房颤动患者的长期预后。然而，在长期随访中，房性心动过速（ATA）复发增加。我们旨在研究 ATA 复发对心房颤动导管消融后长期不良临床事件发展的影响，并确定不良临床事件发展的预测因素。

方法和结果

这项单中心观察性研究纳入了在我院接受首次导管消融治疗的 75 例收缩功能障碍（左心室射血分数<50%）的患者（中位随访时间：3.5[范围：2.4-4.7]年）。我们比较了首次和末次消融后有无 ATA 复发的患者的不良临床事件（全因死亡、心力衰竭住院、卒中和急性心肌梗死）累积发生率。采用多变量分析确定发生不良临床事件的预测因素。

在首次消融后中位 2.2（范围：0.64-2.8）年，21 例患者（28%）发生不良临床事件。首次消融后无不良临床事件的比例在 ATA 复发组显著低于无复发组（41%[n=40]比 95%[n=35]，<0.0005）；末次消融后也呈现出类似的趋势（35%[n=26]比 57%[n=49]，<0.0001）。多变量调整后，ATA 复发是两次消融后不良临床事件的独立预测因素。