Natural history and probability of spontaneous closure of arteriovenous fistulas after radiofrequency catheter ablation of atrial fibrillation

Aim. To evaluate the clinical outcomes of persistent arteriovenous fistulas (AVF) after catheter ablation (CA) of atrial fibrillation (AF), to determine potential predictors and the likelihood of self-resolution while taking anticoagulants.

Methods. Thirty-six patients with AVF after CA AF (14 men, age 59.9±8.4 years) were included. Pulmonary veins were isolated for everyone. Femoral vein catheterization was performed according to anatomical guidelines. Hemostasis was performed with a “figure of eight” type suture, a pouch suture or a compression bandage. With symptoms suggesting the presence of vascular access complications (VAC), ultrasound duplex scanning (UDS) was performed the next day after the CT. When AVF was detected, compression bandages were treated. While maintaining AVF, outpatient follow-up continued, including UDS, echocardiography, and questionnaires. Surgical treatment was performed with a combination of AVF with other VAC, with paired AVF, and with refusal of observation.

Results. The incidence of AVF was 1.19%. Compression therapy was effective in 8 (22.2%) patients, surgical treatment was performed in 7 (19.4%). In no case was AVF symptomatic, and there were no indications for immediate surgical treatment. Outpatient follow-up was continued 14. The duration of follow-up was 24 [12; 28] months. In 8 patients, AVF resolved on its own, in 1 previously closed AVF relapsed. Minor local symptoms were noted in 4 out of 7 patients with persistent AVF. In 15 (41.7%) of 36 patients, AVF resolved independently or with the help of compression therapy. The only independent predictor of self-closure of AVF in a single-factor logistic regression analysis was the age of patients (odds ratio (OR) 0.807; confidence interval (CI) 95% 0.651-1,000; p=0.050). Using ROC analysis, it was shown that the age over 65.5 years reduced the chance of self-closure of AVF by 93.7% (OR 0.067; CI 95% 0.007-0.614; p=0.017).

Conclusion. The frequency of spontaneous closure of AVF after AF was 57.1%. The only independent predictor of AVF persistence was the patient’s age over 65.5 years. None of the patients with persistent AVF developed symptoms of heart failure and vascular symptoms that required immediate surgical closure.

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