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The Mitral Inflow E/A Ratio Before The Procedure May Predict Late Recurrence in Patients With Atrial Fibrillation Undergoing Cryoballoon Ablation

Aim: High recurrence rates after catheter ablation for atrial fibrillation (AF) is a major problem. Many predictors for recurrence after AF ablation have been described. Left ventricular diastolic dysfunction (LV DD) is directly related to most of such predictors. Some studies investigating the relationship between LV DD and late recurrence after AF ablation have found conflicting results. The mitral inflow E/A ratio is a simple and practical method commonly used to evaluate LV DD. We aimed to determine whether the E/A ratio before the procedure was predictive for late recurrence in patients with AF undergoing cryoballoon ablation. Methods: A total of 99 patients undergoing AF ablation for the first time using second-generation cryoballoon were included. Only patients with paroxysmal AF and sinus rhythm the day before the procedure, and pre-procedural pro-B natriuretic peptide levels within normal limits were included. The patients who developed recurrence and those who did not were compared in terms of basal characteristics and procedural features. Any atrial tachyarrhythmia episode longer than 30 s after the blanking period was defined as late recurrence. Results: The patients [age: 58 (50-62) years, 53.5% female] were followed up for a median of 45.0 (15.0-63.0) months and late recurrence developed in 25 (25.2%) patients. The E/A ratio was lower in patients with late recurrence than in those without it [0.5 (0.4-1.2) vs 1.4 (0.6-1.7), respectively, p=0.001]. A multivariate analysis showed that female gender (HR: 4.44, 95%CI: 1.31-15.05, p=0.017), early recurrence (HR: 7.35, 95% CI: 2.28-23.71, p=0.001), and E/A ratio (HR: 0.28, 95%CI: 0.11-0.68, p=0.005) were independent predictors for late recurrence. Conclusions: Female gender, early recurrence, and E/A ratio are independent predictors of late recurrence in patients with AF undergoing cryoballoon ablation. Measuring the E/A ratio in patients with sinus rhythm before AF ablation may help to predict future recurrences.

Credits: Taner Ulus, Ahmet Serdar Yilmaz, Emre ?ener, Halit Emre Yalvaç, Ezgi Çaml?, Fatih Enes Durmaz, Yüksel Çavu?o?lu

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