Atrial fibrillation history impact on catheter ablation outcome. Findings from the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry

Background: Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry. Methods: We described the real-life clinical epidemiology, therapeutic strategies, and the short- and mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (<2 years or ≥2 years). Results: The mean AF history duration was 46.2 ± 57.4 months, 592 patients had an AF history duration <2 years (mean 10.2 ± 5.9 months), and 1356 patients ≥2 years (mean 75.5 ± 63.5 months) (P < 0.001). Patients with AF history duration <2 years were younger; had a lower incidence of hypertension, coronary artery disease, and hypertrophic cardiomyopathy; and had a lower CHA₂DS₂-VaSc Score. At 1 year, the logrank test showed a lower incidence of AF recurrence in patients with AF history duration <2 years (28.9%) than in patients with AF history duration ≥2 years (34.0%) (P = 0.037). AF history duration ≥2 years, overall ablation procedure duration, hypertension, and chronic kidney disease were all predictors of recurrences after the blanking period. Conclusions: In this multicenter registry, performing catheter ablation in patients with an AF history ≥2 years was associated with higher rates of AF recurrences at 1 year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified.