Exercise-based Predictors of Late Recurrence of Atrial Fibrillation After Catheter Ablation

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. The observed freedom from
$AF$
ecurrence during the follow-up was 81 %. Multivariable-adjusted
$Cox$
regression revealed the peak
$VO_{2}$
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 vol{###}-
$ume$
index, left atrial pressure and peak
$VO_{2}$
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.