AF burden versus classical AF classification in predicting arrhythmia recurrence

Preliminary results from the real-world ISOLATION study suggest that atrial fibrillation (AF) burden is predictive of recurrence in participants undergoing AF ablation.

ISOLATION (NCT04342312) is a 2-centre, prospective, observational study aimed at determining predictors of successful ablation in participants with AF [1]. An analysis presented by Dr Zarina Habibi (Maastricht University, the Netherlands) aimed at determining the predictive value of AF burden compared with the canonical classification (i.e. paroxysmal vs persistent) in terms of arrhythmia recurrence [2]. Participants were required to have 3 single-lead ECGs daily for 4 weeks prior to ablation. The AF burden value was determined using maximally selected rank statistics. The final analysis included 261 participants who had both the required ECG measurements and completed the 12-month follow-up.

A total of 65.1% of participants had paroxysmal AF and 34.9% of participants had persistent AF. The cut-off value of 42% burden was selected based on statistical calculations (<42% as low burden and >42% as high burden). As expected, participants with persistent AF had a higher probability of recurrent AF compared with participants with paroxysmal AF (P=0.015). Similarly, according to the 42% burden cut-off, participants with a high burden had more AF recurrence compared with participants with a low burden (P=0.006).

A further subanalysis by burden showed that participants with paroxysmal AF and high burden had fewer recurrences than participants with paroxysmal AF and low burden (P=0.012). However, for participants with persistent AF, the burden cut-off of 42% did not show a significant difference in arrhythmia recurrence.

“Our preliminary results suggest that pre-procedural AF burden is an important predictor of AF recurrences in patients undergoing ablation,” said Dr Habibi.

1. 
   
   1. Verhaert DVM, et al. Front Cardiovasc Med. 2022;9:879139.
   2. Habibi Z, et al. Preprocedural atrial fibrillation burden is associated with recurrence in patients undergoing atrial fibrillation ablation: findings from the ISOLATION AF Ablation Cohort Study. Atrial fibrillation: ablation 1. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202429 April 2024