PhD Scientific Days 2025

Poster Session II. - U: Cardiovascular Medicine and Research

Effects of Response to Electrical Cardioversion Before Catheter Ablation for Persistent Atrial Fibrillation: a Propensity-Score Matched Analysis

Name of the presenter

Boga Márton

Institute/workplace of the presenter

Semmelweis University, Heart and Vascular Center

Authors

Dr Boga Márton¹, Dr Szegedi Nándor¹

1: Heart and Vascular Center

Text of the abstract

Background: We hypothesize that sinus rhythm maintenance in persistent atrial fibrillation (AF) patients taking antiarrhythmic drugs (AADs) after preprocedural electrical cardioversion (ECV) could predict outcomes after catheter ablation procedures.
Methods: A total of 219 persistent AF patients underwent ECV <6 month before ablation. Patients were categorized into two groups according to their response to ECV: patients in whom SR was restored and maintained until the ablation procedure (ECV-SR group), and patients who have had AF recurrence up to the procedure (ECV-AF group). Then, 1:1 propensity score matching was used to create study groups (94-94 patients). The primary outcomes of the present study were freedom from atrial arrhythmia on/off AADs following a single procedure, and recurrence of persistent AF.
Results: Baseline characteristics were similar, with the only significant difference observed in the frequency of additional ablation beyond pulmonary vein isolation, which was higher in the ECV-AF group (19.1% vs 6.4%, p=0.023). The median follow-up duration was 42 (20–73) month. Freedom from atrial arrhythmia was lower in the ECV-AF group compared to ECV-SR patients (at 36 months: 31.4% vs 51.2%, respectively; crude HR =2.58, 95% CI = 1.58–3.70, p<0.001). The most frequent mode of atrial arrhythmia recurrence was paroxysmal AF in the ECV-SR group and persistent AF in the ECV-AF group. The incidence rate for the recurrence of persistent AF was 7.5/100 patient-years (95% CI=4.5–12.5) in the ECV-SR group and 22.8/100 patient years (95% CI=16.0–32.4) in the ECV-AF group. Freedom from persistent AF at 36 month was 84.3% and 54%, respectively (crude HR=3.72, 95% CI = 1.94–7.14, p<0.001). Differences in the risk of the primary outcomes was similar after multivariable adjustment, and in all analyzed subgroups. The rate of progression to permanent AF was 4.3% in the ECV-SR group and 10.6% in the ECV-AF group over the total follow-up (RR= 2.5, 95% CI =0.86–7.34).
Conclusion: Results from this cohort suggests that response to preprocedural ECV could be a useful indicator for patient selection for catheter ablation of persistent AF.
Funding: New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund (EKÖP-2024-167), SE250+ grant (2024/25).