Does catheter ablation cure atrial fibrillation? Single-procedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicentre experience

Abstract

Aims In the last decade, several approaches to ablating triggers and substrates of atrial fibrillation (AF) have been developed. However, most studies have reported data only on short- or medium-term follow-up. The aim of this study was to investigate whether the 1-year efficacy of catheter ablation for AF is predictive of long-term clinical success. Methods and results Between February 2001 and October 2003, 229 consecutive patients affected by drug-refractory paroxysmal or persistent AF underwent a single radiofrequency catheter ablation procedure (anatomical approach in 146 patients and electrophysiologically guided approach in 83 patients). Of these patients, 177 (mean age 59.1 +/- 10.5 years, 57.6% with paroxysmal AF) were free from any atrial arrhythmia recurrence after 12 months. These 177 patients were subsequently followed up for at least another 24 months, by means of electrocardiogram and 24 h Holter monitoring. After a mean follow-up of 49.7 +/- 13.3 months (range 36-83 months), 58.2% of the patients were free from any atrial arrhythmia recurrence (39.5% without antiarrhythmic drugs). The actuarial atrial arrhythmia recurrence rate was 13.0% at 2 years, 21.8% at 3 years, 35.0% at 4 years, 46.8% at 5 years, and 54.6% at 6 years. Atrial arrhythmia-free survival was similar in patients with paroxysmal or persistent AF, with and without antiarrhythmic drugs during the follow-up, who underwent electrophysiologically guided pulmonary vein (PV) isolation or anatomical PV ablation. Conclusion Even patients in whom catheter ablation prevents AF recurrence for 1 year should not be considered 'cured', since >40% of them will suffer AF recurrence over a long-term clinical follow-up.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…63,270,536,1022,1023,1024 A recent meta-analysis analyzed 19 studies including 6167 patients, describing outcomes ≥3 years after AF ablation with a mean follow-up ≥24 months after the index procedure. Single procedure and multiple procedure freedom from atrial arrhythmias has been reported to be 53% and 80%, respectively, with substantial heterogeneity noted for single-procedure outcomes.…”

“…Similar findings have been reported in each of the subsequent trials. 266,267,268,1022,1086,1087 The predictors of late recurrence most commonly identified include persistent AF as well as comorbid conditions. Despite the low single-procedure, long-term success rate reported in virtually all of these clinical trials, they also reveal that with the use of repeat AF ablation procedures and/or AAD therapy, much higher rates of freedom from recurrent AF as well as concomitant reductions in AF burden can be achieved.…”

Catheter Ablation of Lone Atrial Fibrillation

“…In the weeks after the ablation procedure, damaged endothelium represents possible nidus for thrombus formation [120,158]. Although most of AF recurrences are registered in the first 1-2 years, the attention is drawn to appearance of later arrhythmia relapse [79]. Moreover, AF recurrences after the procedure can be completely asymptomatic [3].…”

The matter of economic evaluations in health policy decision-making : The case of the Swedish national guidelines for heart diseases

“…whether the long-term benefits are maintained after the initial RFA procedure. Since the publication of Paper IV, a recent literature search revealed several studies on the long-term effects of the RFA treatment strategy [88][89][90][91][92], confirming the long-term efficiency of RFA. Additionally, a cost-effectiveness analysis on the firstline treatment with RFA for patients with paroxysmal AF, was found [93].…”