TY - JOUR
T1 - Prevalence and outcome of early recurrence of atrial tachyarrhythmias in the Cryoballoon vs Irrigated Radiofrequency Catheter Ablation (CIRCA-DOSE) study
AU - CIRCA-DOSE Study Investigators
AU - Steinberg, Christian
AU - Champagne, Jean
AU - Deyell, Marc W.
AU - Dubuc, Marc
AU - Leong-Sit, Peter
AU - Calkins, Hugh
AU - Sterns, Lawrence
AU - Badra-Verdu, Mariano
AU - Sapp, John
AU - Macle, Laurent
AU - Khairy, Paul
AU - Andrade, Jason G.
N1 - Funding Information:
Funding Sources: The CIRCA-DOSE study was funded by the Heart and Stroke Foundation of Canada (Grant Number G-13-0003121 ), with additional financial support from Medtronic and Heart Rhythm Services at the University of British Columbia . Drs Andrade and Deyell are supported by a Michael Smith Foundation for Health Research Scholar Award. Dr Khairy is supported by a research chair in electrophysiology and congenital heart disease. The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Disclosures: Dr Calkins reports personal fees from Biosense Webster , Inc., Medtronic , Abbott Medical, and AtriCure . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
Funding sources: The CIRCA-DOSE study was funded by the Heart and Stroke Foundation of Canada (Grant Number G-13-0003121), with additional financial support from Medtronic and Heart Rhythm Services at the University of British Columbia. Drs Andrade and Deyell are supported by a Michael Smith Foundation for Health Research Scholar Award. Dr Khairy is supported by a research chair in electrophysiology and congenital heart disease. The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Disclosures: Dr Calkins reports personal fees from Biosense Webster, Inc., Medtronic, Abbott Medical, and AtriCure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 Heart Rhythm Society
PY - 2021/9
Y1 - 2021/9
N2 - Background: Early recurrence of atrial tachyarrhythmia (ERAT) is common after pulmonary vein isolation (PVI) and has been associated with an increased risk of late atrial fibrillation (AF) recurrence. Objective: The purpose of this study was to determine the incidence and outcomes of patients experiencing ERAT after PVI using advanced-generation ablation technologies. Methods: This is a prespecified substudy of the CIRCA-DOSE (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double-Short vs Standard Exposure Duration) trial, a prospective, randomized, multicenter study comparing PVI with contact force–guided radiofrequency ablation to secondary-generation cryoballoon ablation for paroxysmal AF. All study patients received an implantable cardiac monitor to allow continuous rhythm monitoring. ERAT was defined as any recurrent atrial tachyarrhythmia within the first 90 days after AF ablation. Results: ERAT occurred in 61% of the 346 patients at a median of 12 days (range 1–90 days) after ablation. ERAF was a significant predictor of late recurrence (60.1% with ER vs 25.9% without ER; P <.001) and symptomatic atrial tachyarrhythmia (31.6% with ERAF vs 6.7% without ERAF; P <.001). Receiver operating curve analyses revealed a strong correlation between ERAT timing and burden and late recurrence. Multivariate analysis identified ER timing (hazard ratio [HR] 2.90; 95% confidence interval [CI] 1.41–5.95; P =.004) and burden (HR 1.05 per 1% ER burden; 95% CI 1.04–1.07; P <.001) as strong independent predictors of late recurrence. Incidence rate, timing, burden, and prognostic significance of ER did not differ between the study groups. Conclusion: ERAT remains common after PVI despite use of advanced-generation ablation technologies. Early AF recurrence beyond 3 weeks after ablation is associated with increased risk of late recurrence.
AB - Background: Early recurrence of atrial tachyarrhythmia (ERAT) is common after pulmonary vein isolation (PVI) and has been associated with an increased risk of late atrial fibrillation (AF) recurrence. Objective: The purpose of this study was to determine the incidence and outcomes of patients experiencing ERAT after PVI using advanced-generation ablation technologies. Methods: This is a prespecified substudy of the CIRCA-DOSE (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double-Short vs Standard Exposure Duration) trial, a prospective, randomized, multicenter study comparing PVI with contact force–guided radiofrequency ablation to secondary-generation cryoballoon ablation for paroxysmal AF. All study patients received an implantable cardiac monitor to allow continuous rhythm monitoring. ERAT was defined as any recurrent atrial tachyarrhythmia within the first 90 days after AF ablation. Results: ERAT occurred in 61% of the 346 patients at a median of 12 days (range 1–90 days) after ablation. ERAF was a significant predictor of late recurrence (60.1% with ER vs 25.9% without ER; P <.001) and symptomatic atrial tachyarrhythmia (31.6% with ERAF vs 6.7% without ERAF; P <.001). Receiver operating curve analyses revealed a strong correlation between ERAT timing and burden and late recurrence. Multivariate analysis identified ER timing (hazard ratio [HR] 2.90; 95% confidence interval [CI] 1.41–5.95; P =.004) and burden (HR 1.05 per 1% ER burden; 95% CI 1.04–1.07; P <.001) as strong independent predictors of late recurrence. Incidence rate, timing, burden, and prognostic significance of ER did not differ between the study groups. Conclusion: ERAT remains common after PVI despite use of advanced-generation ablation technologies. Early AF recurrence beyond 3 weeks after ablation is associated with increased risk of late recurrence.
KW - Atrial fibrillation
KW - Atrial fibrillation burden
KW - CIRCA-DOSE
KW - Early recurrence of atrial fibrillation
KW - Implantable cardiac monitor
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U2 - 10.1016/j.hrthm.2021.06.1172
DO - 10.1016/j.hrthm.2021.06.1172
M3 - Article
C2 - 34126269
AN - SCOPUS:85109429274
VL - 18
SP - 1463
EP - 1470
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 9
ER -