Searching for potential factors associated with failed catheter ablation of atrial fibrillation. Retrospective analysis of electronic medical records using medical decision making support service (SELECT AF study)

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Objective. To assess whether the characteristics of patients referred for catheter ablation of atrial fibrillation (AF) match the known risk criteria for recurrent arrhythmias; to estimate the number of patients’ EMRs with repeated ablation procedures and compare repeated and primary catheter ablation procedures. Material and methods. The EMRs of 232 AF patients referred for catheter ablation of pulmonary veins were analyzed. The main predictors of AF recurrence were age, body mass index (BMI) and longitudinal size of the left atrium (LA). Results. In 137 (59.1%) patients referred for catheter ablation, there were no predictors of AF recurrence. Previous ablation was observed in 141 (60.8%) patients. The risk of arrhythmia recurrence was found in 49.5% of patients referred for primary procedure and 36.2% of patients in the repeated ablation group. EMRs with a predicted risk of AF recurrence by age comprised 14.3% in the primary ablation group and 5.7% in the repeated ablation group (p=0.026). EMRs with a predicted risk of AF recurrence by BMI comprised 17.6% and 17.7% in both groups, respectively (p=0.977). LA size was identified as a predictor of AF recurrence in 26.4% of cases in the primary ablation group and 18.4% in the repeated ablation group (p=0.152). Conclusion. Patients with recurrent arrhythmias after previous catheter interventions comprise a significant proportion among those with indications for catheter ablation of AF. Selection of patients for redo interventions is carried out more carefully. Modern digital tools are needed to select patients for catheter treatments. This approach can reduce the number of repeated procedures and AF recurrences.

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