Predictors of late recurrence after second catheter ablation for persistent atrial fibrillation

Background: Little has been reported on the predictors of late recurrence (LR) after second radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF). Objective: This study aimed to identify the predictors of LR after second RFCA in patients with persistent AF. Methods: We retrospectively analyzed 123 patients who underwent a second RFCA because of LR after the initial RFCA for persistent AF. LR was defined as a recurrence of atrial tachyarrhythmia >3 months after the ablation procedure. The initial RFCA included pulmonary vein isolation alone or pulmonary vein isolation plus cavotricuspid isthmus block. The predictors of LR were evaluated by the Cox proportional hazards model. Results: In the univariate analysis, elevated brain natriuretic peptide levels, absence of pulmonary vein reconnections at the beginning of the second RFCA, and presence of early recurrence (ER, defined as a recurrence of atrial tachyarrhythmia within 3 months) after the second RFCA were associated with LR (P = .025, P = .018, and P < .001, respectively). The multivariate analysis revealed that absence of pulmonary vein reconnections and presence of ER were independent predictors of LR after the second RFCA (P = .004 and P < .001, respectively). Conclusion: Absence of pulmonary vein reconnections and presence of ER were strongly associated with LR after the second RFCA in patients with persistent AF.