Atrial fibrillation and stroke: how much atrial fibrillation is enough to cause a stroke?

The Cost of Atrial Fibrillation: A Systematic Review

OBJECTIVES

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to AF are both direct and indirect. This systematic review aims to identify the main cost drivers of the illness, assess the potential economic impact resulting from changes in care strategies, and propose interventions where they are most needed.

METHODS

A systematic literature search of the PubMed and Scopus databases was performed to identify analytical observational studies defining the cost of illness in cases of AF. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 recommendations.

RESULTS

Of the 944 articles retrieved, 24 met the inclusion criteria. These studies were conducted in several countries. All studies calculated the direct medical costs, whereas 8 of 24 studies assessed indirect costs. The median annual direct medical cost per patient, considering all studies, was €9409 (13 333 US dollars in purchasing power parities), with a very large variability due to the heterogeneity of different analyses. Hospitalization costs are generally the main cost drivers. Comorbidities and complications, such as stroke, considerably increase the average annual direct medical cost of AF.

CONCLUSIONS

In most of the analyzed studies, inpatient care cost represents the main component of the mean direct medical cost per patient. Stroke and heart failure are responsible for a large share of the total costs; therefore, implementing guidelines to manage comorbidities in AF is a necessary step to improve health and mitigate healthcare costs.

Hourly Heat Exposure and Acute Ischemic Stroke

Importance

Previous studies have demonstrated the associations of daily high temperature with hospitalizations and mortality from ischemic stroke, but the hourly association of ambient heat and acute ischemic stroke (AIS) onset has been rarely examined.

Objectives

To evaluate the association between hourly high ambient temperature and the onset of AIS.

Design, Setting, and Participants

This time-stratified case-crossover study was conducted using a nationwide registry that collects data from more than 200 stroke centers in China. Participants were adult patients with AIS who were hospitalized in the warm seasons between January 1, 2019, and December 31, 2021.

Exposures

Hourly temperature and single-hour temperature exposure lag up to 24 hours before the AIS onset (lag 0 hours to lag 24 hours).

Main Outcomes and Measures

The main outcome was onset of AIS. Associations between hourly mean temperatures and AIS onset were analyzed using conditional logistic regression integrated with the distributed lag nonlinear model. Stratification analyses were applied to examine potential association modifiers. Several sensitivity analyses were conducted to examine the robustness of the results.

Results

A total of 82 455 patients with AIS (mean [SD] age, 65.8 [11.9] years; 52 267 males [63.4%]) were included in the final analysis. A monotonically increasing risk of AIS onset was associated with higher temperatures. The excess AIS risk occurred immediately at lag 0 hours and persisted for 10 hours. Compared with the reference temperature (12.1 °C), the cumulative odds ratio (OR) over lag 0 to 10 hours of AIS onset associated with extremely high temperature (33.3 °C) was 1.88 (95% CI, 1.65-2.13) nationwide. The exposure-response curve was steeper in the north than in the south (OR, 1.80 [95% CI, 1.53-2.11] vs 1.57 [95% CI, 1.31-1.87]). The ORs were greater for males and patients with a history of dyslipidemia or atrial fibrillation, but the differences were not significant.

Conclusions and Relevance

Results of this study suggest that hourly heat exposure is associated with increased risk of AIS onset. This finding may benefit the formulation of public health strategies to reduce cerebrovascular risk associated with high ambient temperature under global warming.

Causal relationship between atrial fibrillation and stroke risk: a Mendelian randomization

OBJECTIVES

This study aimed to investigate the causal relationship between Atrial Fibrillation (AF) and the risk of Stroke using a Mendelian randomization (MR) approach.

METHODS

A two-sample MR analysis was conducted using publicly available genome-wide association study (GWAS) summary statistics data. In this analysis, genetic variants associated with AF were used as instrumental variables to estimate the causal effect. The inverse-variance weighted (IVW) method, weighted median estimator, and MR-Egger regression were employed for estimation. Additionally, sensitivity analysis was performed using the leave-one-out method.

RESULTS

The analysis included 87 single nucleotide polymorphisms (SNPs) associated with AF. The results from the IVW method indicated a positive association between genetic predisposition to AF and the risk of stroke (OR 1.002, 95 % CI 1.001-1.003, P < 0.001). The weighted median and MR-Egger methods showed consistent results (weighted median: OR 1.001, 95 % CI 1.000-1.002, P = 0.034; MR-Egger: OR 1.001, 95 % CI 1.000-1.003, P = 0.086). Sensitivity analysis demonstrated that no individual SNP significantly influenced the causal inference.

CONCLUSIONS

This study provides evidence of a causal relationship between AF and an elevated risk of stroke. These findings emphasize the significance of managing AF in order to prevent and treat strokes. Additional research is required to better understand the underlying mechanisms of this causal association.

Lifeday coverage of oral anticoagulants and one-year relative survival in patients with atrial fibrillation: a population-based study in Estonia

BACKGROUND

Routine oral anticoagulation (OAC) is recommended for almost all high-risk patients with atrial fibrillation, yet registries show that OACs are still underused. Our aim was to study the lifeday coverage (LDC) of OAC prescriptions and its relationship with one-year mortality rates of AF patients aged ≥ 65 in Estonia for the years 2019 and 2020.

METHODS

Medical data for AF patients aged ≥ 65 years from 2018 and alive as of 01.01.2019 (cohort I) and new AF documentation from 2019 and alive as of 01.01.2020 (cohort II) was obtained from the Health Insurance Fund's electronic database. The data was linked to the nationwide Estonian Medical Prescription Centre's database of prescribed OACs. For LDC analysis, daily doses of guideline-recommended OACs were used. The patients were categorized into three LDC groups: 0%, 1-79%, and ≥ 80%. The data was linked to the Estonian Causes of Death Registry to establish the date of death and mortality rate for the whole Estonian population aged ≥ 65.

RESULTS

There were 34,018 patients in cohort I and 9,175 patients with new AF documentation (cohort II), previously not included in cohort I. Of the patients, 77.7% and 68.6% had at least one prescription of OAC in cohorts I and II respectively. 57.4% in cohort I and 44.5% in cohort II had an LDC of ≥ 80%. The relative survival estimates at 1 year for LDC lifeday coverage groups 0%, 1-79%, and ≥ 80% were 91.2%, 98.2%, and 98.5% (cohort I), and 91.9%, 95.2%, and 97.6% (cohort II), respectively.

CONCLUSIONS

Despite clear indications for OAC use, LDC is still insufficient and anticoagulation is underused for stroke prevention in Estonia. Further education of the medical community and patients is needed to achieve higher lifeday coverage of prescribed OACs.

Bayesian Network Meta-analysis of Randomized Controlled Trials on the Efficacy of Antiarrhythmics in the Pharmacological Cardioversion of Paroxysmal Atrial Fibrillation

PURPOSE

Since atrial fibrillation (AF) is one of the major arrhythmias managed in hospitals worldwide, it has a major impact on public health. The guidelines agree on the desirability of cardioverting paroxysmal AF episodes. This meta-analysis aims to answer the question of which antiarrhythmic agent is most effective in cardioverting a paroxysmal AF.

MATERIALS AND METHODS

A systematic review and Bayesian network meta-analysis, searching MEDLINE, Embase, and CINAHL, were performed, including randomized controlled trials (RCTs) enrolling a population of unselected adult patients with a paroxysmal AF that compared at least two pharmacological regimes to restore the sinus rhythm or a cardioversion agent against a placebo. The main outcome was efficacy in restoring sinus rhythm.

RESULTS

Sixty-one RCTs (7988 patients) were included in the quantitative analysis [deviance information criterion (DIC) 272.57; I² = 3%]. Compared with the placebo, the association verapamil-quinidine shows the highest SUCRA rank score (87%), followed by antazoline (86%), vernakalant (85%), tedisamil at high dose (i.e., 0.6 mg/kg; 80%), amiodarone-ranolazine (80%), lidocaine (78%), dofetilide (77%), and intravenous flecainide (71%). Taking into account the degree of evidence of each individual comparison between pharmacological agents, we have drawn up a ranking of pharmacological agents from the most effective to the least effective.

CONCLUSIONS

In comparing the antiarrhythmic agents used to restore sinus rhythm in the case of paroxysmal AF, vernakalant, amiodarone-ranolazine, flecainide, and ibutilide are the most effective medications. The verapamil-quinidine combination seems promising, though few RCTs have studied it. The incidence of side effects must be taken into account in the choice of antiarrhythmic in clinical practice.

CLINICAL TRIAL REGISTRATION

PROSPERO: International prospective register of systematic reviews, 2022, CRD42022369433 (Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369433 ).

Association between serum apolipoprotein A1 and atrial fibrillation in the Chinese population: a case-control study

BACKGROUND

The relationship between serum apolipoprotein A1 (APOA1) and atrial fibrillation (AF) is not known. Therefore, we sought to investigate the associations between APOA1 and AF in the Chinese population.

METHODS

This case-control study included 950 patients with AF (29-83 years old, 50.42% male) who were hospitalized consecutively in China between January 2019 and September 2021. Controls with sinus rhythm and without AF were matched (1:1) to cases by sex and age. Pearson correlation analysis was performed to investigate the correlation between APOA1 and blood lipid profiles. Multivariate regression models were used to explore the association between APOA1 and AF. The receiver operator characteristic (ROC) curve was constructed to examine the performance of APOA1.

RESULTS

Multivariate regression analysis showed that low serum APOA1 in men and women with AF was significantly associated with AF (OR = 0.261, 95% CI: 0.162-0.422, P < 0.001). Pearson correlation analysis indicated that serum APOA1 was positively correlated with total cholesterol (TC) (r = 0.456, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = 0.825, p < 0.001), high-density lipoprotein cholesterol (HDL-C) (r = 0.238, p < 0.001), and apolipoprotein B (APOB) (r = 0.083, p = 0.011). ROC curve analysis showed that APOA1 levels of 1.105 g/L and 1.205 g/L were the optimal cut-off values for predicting AF in males and females, respectively.

CONCLUSION

Low APOA1 in male and female patients is significantly associated with AF in the Chinese population of non-statin users. APOA1 may be a potential biomarker for AF and contribute to the pathological progression of AF along with low blood lipid profiles. Potential mechanisms remain to be further explored.

The Association Between Rheumatoid Arthritis and Atrial Fibrillation: Epidemiology, Pathophysiology and Management

Atrial fibrillation (AF) is the most common cardiac arrhythmia with a significant increase in morbidity and mortality worldwide. Rheumatoid arthritis (RA), as a systemic inflammatory disease, affecting 0.5-1.0% of the adult population, is associated with increased incidence of cardiac arrhythmias such as AF. Several epidemiologic studies find that the risk of AF is increased in RA when compared with the general population. Other studies are inconsistent. Considering that inflammation plays an important role in AF, RA may be involved in the occurrence and development of AF. This review summarizes the epidemiology, pathophysiology, and management of AF in patients with RA.

Reporting quality of randomized controlled trials evaluating non-vitamin K oral anticoagulants in atrial fibrillation: a systematic review

BACKGROUND

Randomized controlled trials (RCTs) are subject to bias if they lack methodological quality. Furthermore, optimal and transparent reporting of RCT findings aids their critical appraisal and interpretation. This study aimed to comprehensively evaluate the report quality of RCTs of non-vitamin K oral anticoagulants (NOACs) for the treatment of atrial fibrillation (AF) and to analyze the factors influencing the quality.

METHODS

By searching PubMed, Embase, Web of Science, and Cochrane Library databases RCTs published from inception to 2022 evaluating the efficacy of NOACs on AF were collected. By using the 2010 Consolidated Standards for Reporting Tests (CONSORT) statement, the overall quality of each report was assessed.

RESULTS

Sixty-two RCTs were retrieved in this study. The median of overall quality score in 2010 was 14 (range: 8.5-20). The extent of compliance with the Consolidated Standards of Reporting Trials reporting guideline differed substantially across items: 9 items were reported adequately (more than 90%), and 3 were reported adequately in less than 10% of trials. Multivariate linear regression analysis showed that the higher reporting scores were associated with higher journal impact factor (P = 0.01), international collaboration (P < 0.01), and Sources of trial funding (P = 0.02).

CONCLUSIONS

Although a large number of randomized controlled trials of NOACs for the treatment of AF were published after the CONSORT statement in 2010, the overall quality is still not satisfactory, thus weakening their potential utility and may mislead clinical decisions. This survey provides the first hint for researchers conducting trials of NOACs for AF to improve the quality of reports and to actively apply the CONSORT statement.

Comparison of radiofrequency ablation and antiarrhythmic drug for the treatment of atrial fibrillation: A protocol for systematic review and meta-analysis

BACKGROUND

Antiarrhythmic drugs and radiofrequency ablation are first-line treatments of atrial fibrillation, however, there exists a paucity of data regarding the potential benefit of different catheter ablation technologies versus antiarrhythmic drugs as an early rhythm strategy. We performed a protocol for systematic review and meta-analysis to compare the efficacy and safety of radiofrequency ablation and antiarrhythmic drugs for the treatment of atrial fibrillation.

METHODS

This review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022375095). Additionally, this review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 Statement. A computerized literature search will be performed in the following electronic databases from their inceptions to November 2022: PubMed, EMBASE, MEDLINE, Cochrane Central Register of Controlled Clinical Trials, China Knowledge Resource Integrated Database, Wanfang Data Information, and Weipu Database for Chinese Technical Periodicals. The risk of bias will be assessed independently by 2 authors using the Cochrane tool of risk of bias. All statistical analyses will be conducted using the software program Review Manager version 5.3.

RESULTS

The results of this systematic review will be published in a peer-reviewed journal.

CONCLUSION

This study provides evidence of the comparison of radiofrequency ablation and antiarrhythmic drugs for the treatment of atrial fibrillation.

Correlation of microembolism risk factors with age in the ischemic stroke recovery period

Identification of the age-related features of interaction between the risk factors of microembolism can improve understanding of the mechanisms underlying the development of ischemic stroke (IS). The study was aimed to assess the effects of age and other risk factors of stroke on the biophysical characteristics of microembolic signals (MES) recorded during the ischemic stroke recovery period. Transcranial Doppler ultrasound (TCD) involving microembolus detection (MED) was performed in 515 people, the data of 28 patients having a history of ischemic stroke, among them 9 women (32%) and 19 men (68%) aged 33–78 (average age 58 ± 13 years), were included in the study. Using the mixed-effects linear model it was found that age and interaction between age and atrial fibrillation affected the power of MES. The increase in the power of the recorded MES with age is observed, that is especially evident in patients with atrial fibrillation (р < 0.0005). As for cardioembolic IS variant, the power and duration of MES turn out to be significantly higher in elderly patients (p < 0.0005). The power of MES gradually increases with age in patients with no atherosclerosis and gradually decreases in patients with atherosclerosis, while MES power in patients with atherosclerosis in general (all age groups) is significantly higher (р < 0.0005) than that observed in patients with no atherosclerosis.

Risk factors for stroke in a population of central China: A cross-sectional study

The incidence and mortality rates of stroke in China are higher than the world average, seriously endangering the public's health and quality of life. It is important to predict the incidence of stroke, identify the high-risk factors in the region, and raise the risk awareness of high-risk groups. This study sought to investigate and analyze the distribution of stroke population and the main risk factors for stroke occurrence in a Chinese population, and to predict the probability of stroke occurrence in high-risk groups with risk factors, so as to provide a scientific basis for the comprehensive prevention and treatment of stroke. A whole-group sampling method was used to investigate 1009 participants in Jingzhou city in central China, and a uniform questionnaire survey and related medical examinations were conducted. The risk factors for stroke in the area were analyzed by univariate analysis, and a multifactorial logistic regression prediction model was established based on the results of univariate analysis. The results of univariate and multifactorial logistic regression analyses suggested that gender, age, family history of stroke, hypertension, atrial fibrillation, diabetes, and sedentary lifestyle were significantly associated with an increased risk of stroke in the local population (all P < .05). The top 5 risk factors for stroke were atrial fibrillation (odds ratio [OR] = 5.225, 95% confidence interval [CI]: 2.826-9.663), sedentary lifestyle (OR = 2.701, 95% CI: 1.667-4.376), age (≥65 years) (OR = 2.593, 95% CI: 1.680-4.004), hypertension (OR = 2.106, 95% CI: 1.380-3.216), and gender (male) (OR = 2.099, 95% CI: 1.270-3.471). This study effectively identifies the high risk factors for stroke and provides scientific insights for risk assessment, intervention of risk factors, and decision making of health management departments in the central region of China. The modifable risk factors for stroke such as smoking, hypertension, atrial fibrillation, diabetes mellitus, and sedentary lifestyle were also observed. Our findings further highlight the significant of the primary and secondary prevention for stroke and reveal the potential targets to reduce the heavy stroke burden in China around the world.

A case-control study to investigate association between serum uric acid levels and paroxysmal atrial fibrillation

The relationship between serum uric acid (SUA) levels and paroxysmal atrial fibrillation (AF) remains controversial. The objective of this case–control study was to investigate the association between serum SUA levels and paroxysmal AF by gender in 328 patients. This study included 328 hospitalized patients with newly diagnosed paroxysmal AF in China between January 2019 and September 2021. Controls with sinus rhythm were matched (2:1) to cases by age and gender. Baseline data were analyzed using ANOVA, T-test, and Chi-square test. Pearson correlation analyses were used to confirm the correlation between variables, and multivariate regression analyses were used to adjust for covariates. Elevated SUA levels in female patients were significantly associated with paroxysmal AF after adjusting for confounding factors (OR = 1.229, 95% CI 1.058–1.427, P = 0.007). Further results showed SUA levels were negatively correlated with high-density lipoprotein cholesterol (HDL-C) (r = − 0.182, p = 0.001) and apolipoprotein A1 (APOA1) (r = − 0.109, p = 0.049), were positively correlated with low-density lipoprotein cholesterol (LDL-C) (r = 0.169, p = 0.002) and prealbumin (PAB) (r = 0.161, p = 0.004) . Nevertheless, there was no significant complication difference between SUA levels and paroxysmal AF (P > 0.05). Increased SUA in female patients was significantly associated with paroxysmal AF in a Chinese population. This finding implies that it would be interesting to monitor and interfere with hyperuricemia in paroxysmal AF patients.

Association between serum apolipoprotein B and atrial fibrillation: a case-control study

The relationship between apolipoprotein B (APOB) and atrial fibrillation (AF) is less well-known. We aimed to investigate the association between APOB and AF by gender. We conducted a case-control study including 1913 consecutive hospitalized patients to analyze the association between APOB and AF. 950 AF patients and 963 age-, sex-matched non-AF patients with sinus rhythm were evaluated. T-test, Mann-Whitney test, ANOVA, and Chi-square analysis were performed to analyze baseline data and intergroup comparisons. Pearson's correlation tests or Spearman correlation tests were performed to determine the interrelationships. Multiple regression analysis was performed to adjust for covariables. The receiver operator characteristic (ROC) curve was constructed to examine the performance of APOB. AF patients had lower APOB (P < 0.001) and an independent negative association between APOB and AF in both genders adjusting for confounding factors (OR 0.121, 95% CI 0.067-0.220, P < 0.001), regardless of statin use. APOB was positively correlated with total cholesterol (TC) (r = 0.529, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = 0.545, p < 0.001), apolipoprotein A1 (APOA1) (r = 0.083, p < 0.001), and albumin (ALB) (r = 0.134, p < 0.001). ROC curve analysis showed that APOB level = 0.895 g/L was the most optimal cut-off value, the area under the ROC curve was 0.722. This study shows a protective association of APOB with AF in men and women. It implies APOB may be a potential biomarker for AF with a promising cut-off point of 0.895 g/L and may involve initiating and maintaining AF along with several metabolic factors.

Endovascular thrombectomy for acute ischemic stroke in elderly patients with atrial fibrillation

Background

To assess the clinical outcomes after endovascular thrombectomy (EVT) in elderly large vessel occlusion (LVO)-related acute ischemic stroke (AIS) patients with atrial fibrillation (AF).

Methods

Between January 2019 and December 2020, consecutive AF patients who received EVT due to anterior-circulation stroke were enrolled. The primary outcome was modified Rankin scale (mRS) score at 90 days. Secondary outcomes included all-cause mortality, the recanalization status after EVT (assessed using modified thrombolysis in cerebral infarction scale, mTICI) and any intracranial hemorrhage (ICH). A multivariate logistic regression model was performed to identify predictors of the functional outcome.

Results

A total of 148 eligible patients were finally enrolled. Among them, 42 were ≥ 80 years old. Compared to their younger counterparts, patients aged ≥80 years had lower likelihood of good functional outcome (mRS score 0–2) at 90 days (26.2% vs. 48.1%, P = 0.015), less satisfied recanalization (mTICI, 2b-3) (78.6% vs. 94.3%, P = 0.004) and higher all-cause mortality rate (35.7% vs. 14.2%, P = 0.003). A multivariable logistic regression analysis showed that age ≥ 80 years at baseline were the significant predictors for a poor functional outcome (OR: 3.72, 95% CI: 1.17–11.89, p = 0.027). Intravenous thrombolysis (IVT) prior to EVT and longer time intervals from onset of symptoms to EVT tended to be associated with poor functional outcome in patients ≥80 years old.

Conclusions

Age ≥ 80 years was a significant predictor of unfavorable outcomes after EVT for AIS patients with AF. An increased risk of adverse events must be balanced against the benefit from EVT in elderly patients with AF.

Prevalence and factors associated with atrial fibrillation in older patients with obstructive sleep apnea

Purpose

This study sought to identify the prevalence and factors associated with atrial fibrillation (AF) in older patients with obstructive sleep apnea (OSA) in China. 

Methods

This was an explorative cross-sectional study. Between January 2015 and October 2017, we continuously recruited 1285 older patients with OSA who underwent overnight polysomnography from sleep centers of multiple hospitals. They were assessed using 12-lead ECG or 24-h dynamic ECG, and their baseline demographics, clinical characteristics, sleep parameters, and medical history were determined. Multivariate binary logistic regression analysis was used to investigate the factors related to AF in these older patients with OSA.

Results

The clinician classified 122 (9.5%) patients as having AF. The prevalence of AF significantly increased with age (P < 0.05) but did not significantly differ between the mild, moderate, and severe OSA groups. Additionally, the prevalence of paroxysmal AF was 7.2% among the overall study population, and it increased with OSA severity or advanced age (P < 0.05). Persistent AF was noted in 2.3% participants, and the prevalence also increased with age. The logistic regression analysis showed that age (OR = 1.054, 95%CI: 1.027–1.018, P < 0.001), history of drinking (OR = 1.752, 95%CI: 1.070–2.867, P < 0.05), chronic heart disease (OR = 1.778, 95%CI: 1.156–2.736, P < 0.01), diabetes mellitus (OR = 1.792, 95%CI: 1.183–2.713, P < 0.01), and reduced diastolic function (OR = 2.373, 95%CI = 1.298–4.337, P < 0.01) were relevant to AF among participants with OSA.

Conclusion

The prevalence of AF is significantly common in older patients with OSA. Age, history of drinking, chronic heart disease, diabetes mellitus, and reduced diastolic function are independently related to AF in these patients.

The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation

Background

Catheter ablation has emerged as a major strategy for paroxysmal atrial fibrillation (PAF). Atrial electrical remodeling (AER) plays a critical role in the recurrence of PAF after ablation.

Hypothesis

To characterize the immediate trends of AER during ablations in patients with PAF, and assess the relationship between immediate trends and recurrence.

Methods

We performed this prospective observational study of 135 patients to investigate AER following three ablation modes: radiofrequency ablation (RFA), cryoablation (CA) and 3D mapping‐guided cryoablation (3D‐CA). The atrial effective refractory period (AERP) and atrial conduction time (ACT) were measured via electrophysiology before and immediately after ablation, and P‐wave indices were measured via electrocardiography before and within 24 h after ablation. Follow‐up visits were conducted for at least 1 year or until relapse.

Results

Different approaches of ablation caused a fairly significant increase in the shortest P‐wave duration and AERP in both the proximal coronary sinus (PCS) and distal coronary sinus (DCS) but caused a shortened P‐wave dispersion. No different effect was found at the AERP among the three modes. Compared to patients who received CA, among patients who received RFA, a significant reduction in total ACT and right ACT was seen. Statistically, there was a weakly positive association between changes in total ACT and early recurrence.

Conclusions

Injury during ablation for PAF was associated with an increase in the AERP but not in the ACT. Total ACT and right ACT were shorter after RFA than after CA. The increase in total ACT were slightly predictive of early recurrence.