Efficacy and risk factors for recurrence of atrial fibrillation after radiofrequency ablation of the pulmonary vein orifices

Aim. To compare the efficacy of pulmonary vein radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) between two temporal cohorts (2016-2018 and 2021-2022) and to identify factors affecting the likelihood of arrhythmia recurrence.
Material and methods. The study sequentially enrolled two patient cohorts. All patients underwent pulmonary vein RFA. The first cohort included 78 patients recruited between 2016 and 2018. The second cohort included 92 patients recruited between 2021 and 2022. The incidence of AF recurrence was assessed at 3, 6, and 9 months post-ablation. All arrhythmia recurrences and complications were confirmed by medical documentation. A range of factors potentially influencing AF recurrence was evaluated, including sex, age, body mass index, AF type, presence of atrial flutter, duration of AF history, echocardiographic parameters, comorbidities, procedural volume and duration, intraoperative electrical cardioversion, and antiarrhythmic drug therapy. Regression analysis with logistic regression equations was used to assess the impact of factors on endpoints. A p-value of 0.05 was adopted as the critical significance level.
Results. In the first cohort (2016-2018), the overall RFA efficacy was 65.4%, compared to 83% in the second cohort (2021-2022). Early recurrences were more frequent in the first cohort, while the second cohort exhibited more delayed arrhythmia recurrences. Belonging to the second cohort significantly reduced the risk of atrial fibrillation recurrence (OR 0.46, 95% CI [0.21; 0.97], p=0.04). Conversely, a history of myocardial infarction increased the recurrence risk (OR 12.08, 95% CI [1.46; 251.25], p=0.03). The overall complication rate included four cases of intraoperative hemopericardium and one cardioembolic stroke in the first cohort, and one case each of hemopericardium and cardioembolic stroke in the second cohort. No deaths occurred during the study period.
Conclusion. Modern RFA approaches (including earlier application of the procedure and accumulated surgical experience) provide high efficacy in treating atrial fibrillation. A history of myocardial infarction is an independent predictor of recurrence requiring enhanced monitoring. The obtained data confirm the importance of standardizing ablation timing and comprehensive assessment of cardiovascular risk factors.

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