Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation.

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.
Competing Interests: DG reports: institutional research grants from Boston Scientific and Medtronic, and speaker fees from Boston Scientific. AB reports consultant or speaker fees from Medtronic. The other authors report no conflicts of interest.
(© 2024 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)