Po-01-102 risk factors for progression of paroxysmal to persistent atrial fibrillation following pv isolation

Progression from paroxysmal (PAF) to persistent atrial fibrillation (PerAF) following effective PV isolation (PVI) has important clinical implications, as it is relevant for subsequent management of the arrhythmia. We evaluated risk factors responsible for progression of PAF to PerAF following successful PVI. Consecutive AF patients that received their first and second catheter ablation at our center were identified (n=1352). Patients were included in group 1 if the diagnosis was PAF at both first and redo procedure (PAF to PAF) and group 2 if PAF at index progressed to PerAF at redo. Two blinded electrophysiologists confirmed AF type before the first and the redo ablation procedure. All patients received PV isolation plus isolation of left atrial posterior wall and superior vena cava at the first procedure. A total of 822 patients remained as PAF at redo (group 1), whereas 530 (39%) progressed from PAF to PerAF at the first repeat procedure (group 2). The first AF ablation was performed early (<12 month after diagnosis) in 690 (84%) and 191 (36%) of group 1 and 2 patients respectively (p<0.001). Clinical characteristics of the study population are presented in table 1. In multivariate analysis, BMI (OR 1.02, 1.01-1.04, p=0.04), hypertension (1.4, 1.08-1.8, p=0.01), heart failure (1.67, 1.03-2.69, p=0.03), LA size (2.75, 2.29-3.31, p<0.001) and LVEF (0.97, 0.95-0.98, p<0.001) were independent predictors of progression of PAF to PerAF. In this series, significantly higher number of patients receiving early ablation remained as PAF compared to those that progressed to PerAF. After successful PVI, progression of PAF to PerAF was mediated by independent risk factors such as high BMI, heart failure, hypertension, larger LA size and lower LVEF.