Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Background Radiofrequency catheter ablation (RFCA) for long-standing persistent atrial fibrillation (L-PeAF) is challenging and has a relatively high recurrence rate. We explored clinical and genetic characteristics associated with being good responders (no early or clinical recurrence within 12 months in the absence of anti-arrhythmic drugs) to RFCA among patients with L-PeAF. Methods Of 1319 patients in the Yonsei AF Ablation Cohort, this study included 141 consecutive patients with L-PeAF (80.9% male, age 57.8 ± 9.7 years) who were followed >12 months after RFCA. Results During 25 (19–35) months follow-up, the recurrence rate was 39%, and 38 patients (27%) were categorized as good responders, those had a shorter AF duration (p = 0.010), and smaller left atrial (LA) size (p = 0.033) than others. The rs2106216 (16q22/ZFHX3) genetic polymorphism was independently associated with being a good responder in multivariate analysis (adjusted OR = 2.70, 95% CI 1.41–5.14, p = 0.003), after adjusting for LA size and AF duration. The rs2106261 had predictive value for clinical recurrence of AF after RFCA among patients with an AF duration 12–65 months (log rank, p = 0.025). Conclusions Despite a relatively high recurrence rate after RFCA for L-PeAF, patients with a shorter AF duration and smaller LA size showed a more favorable outcome. The rs2106216 polymorphism (ZFHX3) was independently associated with being good responders to RFCA for L-PeAF, especially with AF duration 12–65 months.