Impact of Pre-Procedural Rhythm Status on Atrial Fibrillation Recurrence and Outcomes Post-PVI: Insights from a National Multicenter Ablation Registry - The 72nd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Feras Haskiah ¹ Eyas Massalha ¹ Ibrahim Marai ² Yoav Michowitz ³ Michael Glikson ³ Yuval Konstantino ⁴ Mordichai Haim ⁴ David Luria ⁵ Alexander Omelchenko ⁶ Avishag Laish-Farkash ⁷ Mahmoud Suleiman ⁸ Eyal Nof ¹ Roy Beinart ¹

¹Leviev Heart Cente, Sheba Medical Center, Ramat Gan, Israel, Israel
²Cardiological ICU, Baruch Padeh Medical Center, Israel
³Cardiology, Shaare Zedek Medical Center, Israel
⁴Cardiology, Soroka University Medical Center,, Israel
⁵Cardiology, Hadassah University Medical Center,, Israel
⁶Cardiology, Meir Medical Center, Israel
⁷Cardiology, Assuta Ashdod University Hospital, Israel
⁸Cardiology, Rambam Health Care Campus, Israel

Background: Pulmonary vein isolation (PVI) is increasingly recognized as a cornerstone treatment for paroxysmal and persistent atrial fibrillation (AF). Despite its growing usage, a notable number of patients experience arrhythmia recurrence.

Purpose: To determine whether pre-procedural rhythm status impacts recurrence rates and clinical outcomes in AF patients treated with PVI.

Methods: Data were drawn from the Israeli Catheter Ablation Registry (ICAR), a prospective, multicenter registry of AF ablations conducted at 14 centers between January 2019 and December 2021. Patients were divided into two groups based on rhythm at the time of ablation: sinus rhythm and non-sinus rhythm. Baseline characteristics, procedural details, and follow-up data, including AF recurrence and hospitalization rates were prospectively collected. The primary outcome was post-blanking AF recurrence within a 2-year follow-up period.

Results: Among 1002 patients, 674 (67.3%) were in sinus rhythm and 328 (32.7%) in non-sinus rhythm at the time of PVI. Patients in sinus rhythm were younger (63.2 ±11.8 vs. 65.7 ±9.9 years, p<0.01), had higher left ventricular ejection fraction (LVEF) (56.1±9.2 vs. 51.0 ±12.1, p<0.01), and more commonly had paroxysmal AF (83.0% vs. 29.1%, p<0.01). The sinus rhythm group experienced significantly lower AF recurrence rates at 2 years (18.7% vs. 24.7%, p=0.03) and fewer hospitalizations (15.0% vs. 23.5%, p=0.001). A Multivariable COX proportional hazard regression model showed that non-sinus rhythm at PVI was independently associated with higher 1-year AF recurrence rates (HR 1.64, 95% CI [1.08-2.48], p=0.02).

Conclusion: Patients in sinus rhythm at the time of PVI exhibited lower AF recurrence rates and reduced hospitalization. These findings support a treatment approach focused on achieving and maintaining sinus rhythm before PVI to optimize outcomes in AF patients.