Freedom from atrial fibrillation at 1 year is estimated to be between 55–80 % of patients undergoing catheter ablation. A significant number of them would require repeat procedures due to recurrent AF. Patients at higher risk for developing recurrent AF could benefit from different ablation strategies and post-ablation rhythm control therapy. We aim to identify the exercise-based risk factors associated with the first recurrence of AF between 3 and 36 months following the ablation.
Patients (n=98, 69.4 % men) referred for catheter ablation of paroxysmal AF underwent simultaneous arm ergometry, exercise echocardiography and invasive left atrial pressure measurements. After the index ablation procedure, follow-up visits were scheduled at 1 up to 36 months. The observed freedom from AF recurrence during the follow-up was 81 %. Multivariable-adjusted Cox regression revealed the peak VO2 as the most significant predictor of late AF reccurence (hazard ratio 0.53, p<0.005). Among analyzed parameters, the lowest prediction error was achieved by including left atrial volume index, left atrial pressure and peak VO2 into age and sex adjusted Cox model (AIC=132.02, C-statistics=0.83).
Presence of either decreased exercise capacity or elevated left atrial pressure is able to identify patients with potentially impaired left atrial function and different clinical outcome after conventional pulmonary vein isolation.