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Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation
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Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation
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Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation
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Journal Article
Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation
2024
Overview
Background Patients who have recurrent atrial fibrillation (AF) following redo catheter ablation may eventually be managed with a pace‐and‐ablate approach, involving pacemaker implant followed by atrioventricular nodal ablation (AVNA). We sought to determine which factors would predict subsequent AVNA in patients undergoing redo AF ablation. Methods We analyzed patients undergoing redo AF ablations between 2013 and 2019 at our institution. Follow‐up was censored on December 31, 2021. Patients with no available follow‐up data were excluded. Time‐to‐event analysis with Cox proportional hazard regression was used to compare those who underwent AVNA to those who did not. Results A total of 467 patients were included, of whom 39 (8.4%) underwent AVNA. After multivariable adjustment, female sex (aHR 4.68 [95% CI 2.30–9.50]; p < 0.001), ischemic heart disease (aHR 2.99 [95% CI 1.25–7.16]; p = 0.014), presence of a preexisting pacemaker (aHR 3.25 [95% CI 1.10–9.60]; p = 0.033), and persistent AF (aHR 2.22 [95% CI 1.07–4.59]; p = 0.032) were associated with increased risk of subsequent AVNA requirement. Conclusion Female sex, ischemic heart disease, and persistent AF may be useful clinical predictors of the requirement for subsequent AVNA and may be considered as part of shared clinical decision making. Atrioventricular (AV) nodal ablation may be required for the treatment of atrial fibrillation (AF) when rhythm control measures fail. Our study found that female sex, ischemic heart disease, preexisting pacemaker, and persistent AF were independent predictors of the need for subsequent AV node ablation.
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