Incidence and Risk Factors for Atrial Fibrillation Recurrence after Ablation of Nodal and Atrioventricular Reentrant Tachycardia: A Meta-analysis

Estelle Torbey; Boutros Karam; Elsa Sleiman; Rabih Tabet; Malcolm Kirk; David Donaldson; Antony D Chu

doi:10.7759/cureus.7824

Incidence and Risk Factors for Atrial Fibrillation Recurrence after Ablation of Nodal and Atrioventricular Reentrant Tachycardia: A Meta-analysis

Cureus. 2020 Apr 25;12(4):e7824. doi: 10.7759/cureus.7824.

Authors

Estelle Torbey¹, Boutros Karam², Elsa Sleiman³, Rabih Tabet⁴, Malcolm Kirk⁵, David Donaldson⁵, Antony D Chu⁵

Affiliations

¹ Electrophysiology, Rhode Island University Hospital - Warren Alpert Medical School of Brown University, Rhode Island, USA.
² Cardiology, Staten Island University Hospital - Northwell Health, Staten Island, USA.
³ Internal Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA.
⁴ Cardiovascular Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA.
⁵ Cardiology, Rhode Island University Hospital - Warren Alpert Medical School of Brown University, Rhode Island, USA.

Abstract

Introduction Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are frequently associated with atrial fibrillation (AF). Targeting the slow or accessory pathways has been advocated as therapy for coexisting AF. But in practice, AF has frequently recurred after ablation, possibly because of various risk factors. The objective of this study is to investigate these risk factors and check for their significance in AF recurrence. Materials and methods A systematic review of Medline, Cochrane, and ClinicalTrials.gov databases was conducted. Articles that studied AF recurrence after either AVNRT or AVRT ablation were reviewed. Publication bias was adequately assessed, and the random method was applied for all dichotomous values. Finally, the odds ratio (OR) and confidence intervals (CI) were calculated for each risk factor. Results Four studies were included, with a total of 1,308 participants. Only 218 participants had dual tachycardia (AF with either AVNRT or AVRT). The mean follow-up time was 29 +/- 3.3 months. The mean age was 56 +/- 15 years. Age constituted the only significant risk factor for AF recurrence (OR: 3.4, CI: 2.1-5.3, p<0.001). Atrial vulnerability did not significantly correlate with a higher risk of AF recurrence (OR: 4.8, CI: 0.7-29, p<0.008). Again, neither male gender (OR: 1.5, CI: 0.8-2.8, p<0.16) nor left atrial diameter (OR: 1.5, CI: 0.2-10, p<0.67) were significant risk factors for recurrence of AF. Conclusion Older age was the only significant predictor of AF recurrence after ablation of AVNRT or AVRT. Further studies are needed to determine the age cut-off at which concomitant pulmonary vein isolation would be beneficial in patients undergoing ablation of AVNRT/AVRT.

Keywords: atrial fibrillation; atrio-ventricular nodal re-entrant tachycardia; atrio-ventricular re-entrant tachycardia; catheter ablation; recurrence predictors.