Li Sitong, Zhang Jingrui, Zuo Song, Wang Jue, Lai Yiwei, Li Mingxiao, Yang Zejun, Zhao Zixu, Zhao Manlin, Ren Lan, Wang Zhen, Jiang Chao, He Liu, Guo Xueyuan, Liu Xiaoxia, Tang Ribo, Zhou Ning, Sang Caihua, Long Deyong, Du Xin, Dong Jianzeng, Ma Changsheng
Department of Cardiology, Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing China.
Heart Health Research Center Beijing China.
J Am Heart Assoc. 2025 May 6;14(9):e038832. doi: 10.1161/JAHA.124.038832. Epub 2025 Apr 17.
Atrial arrhythmia recurrence after atrial fibrillation (AF) catheter ablation is conventionally assessed as a binary end point. However, the prognostic value of recurrence patterns is less studied.
This study included patients undergoing catheter ablation from the multicenter China Atrial Fibrillation Registry study (2011-2022). Postablation AF patterns within 1 year were categorized as nonrecurrence, paroxysmal AF recurrence, or persistent AF (PersAF) recurrence. Cardiovascular outcomes included cardiovascular death, thromboembolism, and cardiovascular hospitalization. Cox proportional models with landmark analysis were used to assess the relationship between recurrence patterns and outcomes. Sensitivity analyses were conducted using Fine-Gray models, considering death unrelated to the outcomes as the competing risk and evaluating 2-year recurrence patterns. Among 13 811 patients (mean age, 60.5±10.8 years; 66.1% men), those with preablation PersAF, prior stroke/transient ischemic attack/systemic embolism, and increased left atrial diameter were more likely to develop PersAF postablation. Compared with nonrecurrence, PersAF recurrence was associated with higher risks of cardiovascular death (hazard ratio [HR], 2.03 [95% CI, 1.20-3.43]; =0.009), thromboembolism (HR, 1.50 [95% CI, 1.09-2.06]; =0.012), and cardiovascular hospitalization (HR, 1.74 [95% CI, 1.56-1.94]; <0.001) during a median follow-up of 3.02 years (interquartile range, 1.44-5.03 years), while paroxysmal AF recurrence was only significantly associated with an increased risk of cardiovascular hospitalization (HR, 1.98 [95% CI, 1.83-2.14], <0.001). Sensitivity analyses yielded consistent results.
Postablation PersAF recurrence was associated with significantly higher risks of cardiovascular death and thromboembolism, compared with paroxysmal AF recurrence and nonrecurrence, indicating the prognostic importance of recurrence patterns.
URL: www.chictr.org.cn/; unique identifier: ChiCTR-OCH-13003729.
心房颤动（AF）导管消融术后房性心律失常复发通常作为一个二元终点进行评估。然而，复发模式的预后价值研究较少。
本研究纳入了多中心中国心房颤动注册研究（2011 - 2022年）中接受导管消融的患者。将术后1年内的房颤模式分为无复发、阵发性房颤复发或持续性房颤（PersAF）复发。心血管结局包括心血管死亡、血栓栓塞和心血管住院。采用带标志性分析的Cox比例模型评估复发模式与结局之间的关系。使用Fine - Gray模型进行敏感性分析，将与结局无关的死亡视为竞争风险并评估2年复发模式。在13811例患者（平均年龄60.5±10.8岁；66.1%为男性）中，消融术前有持续性房颤、既往有卒中/短暂性脑缺血发作/全身性栓塞以及左心房直径增加的患者消融术后更易发生持续性房颤。与无复发相比，在中位随访3.02年（四分位间距1.44 - 5.03年）期间，持续性房颤复发与心血管死亡风险更高相关（风险比[HR]，2.03[95%CI，1.20 - 3.43]；P = 0.009）、血栓栓塞（HR，1.50[95%CI，1.09 - 2.06]；P = 0.012）和心血管住院（HR，1.74[95%CI，1.56 - 1.94]；P < 0.001），而阵发性房颤复发仅与心血管住院风险增加显著相关（HR，1.98[95%CI，1.83 - 2.14]，P < 0.001）。敏感性分析得出一致结果。
与阵发性房颤复发和无复发相比，消融术后持续性房颤复发与心血管死亡和血栓栓塞风险显著更高相关，表明复发模式的预后重要性。
网址：www.chictr.org.cn/；唯一标识符：ChiCTR - OCH - 13003729
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