Five-Year Outcomes After Segmental Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Abstract

Introduction Most trials evaluating the efficacy of atrial fibrillation ablation report follow-up periods of 1–2 years. Long term results (> 5 years) following segmental pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) are largely unreported. Objective To evaluate the long-term efficacy of segmental PVI for the treatment of symptomatic, medically refractory, PAF. Methods Patients with paroxysmal atrial fibrillation who underwent pulmonary vein isolation at the University of California, San Diego Medical Center were evaluated retrospectively to determine the outcome of the index procedure. Of one hundred and eighteen segmental pulmonary vein isolation procedures preformed at UCSD Medical Center between January 1, 2002 and August 31, 2003, seventy-one patients who had long-term follow-up data were included. The five year outcomes were determined by last clinic encounter and telephone encounter at or after five years from the index procedure. Patients had routine clinic visits with EKGs and underwent cardiac monitoring for any complaints of symptoms suggestive of recurrent arrhythmia. Results Seventy-one patients (60±10 years, 56 male) were followed for > 5 years. After one procedure, with 12 months of follow up, sixty-one (86%) of patients were free from symptomatic atrial fibrillation (AF). After 24 months, fifty-six (79%) of patients remained free of AF. At the end of a follow up period of 63±5 months, only forty patients (56%) remained free from symptomatic atrial fibrillation after one procedure. In sixteen patients (22.5%), atrial fibrillation recurred after the second year post-ablation, with four patients recurring during the third year, four patients during the fourth year, and eight patients having their first recurrence of atrial fibrillation greater than 48 months after their index ablation procedure. Thirty-one patients underwent more than one ablation procedure (average 1.9±0.9 procedures per patient). After multiple procedures, sixty patients (84%) were arrhythmia free off medication at 63±5 months after their initial procedure. In patients who underwent more than one ablation procedure, the mean duration of follow up after the last ablation procedure was 7.5±2.1 months. Conclusions Overall five-year outcomes after segmental PVI for PAF are consistent with previously reported shorter term follow-up (≤ 2 years); however, late recurrences (>2 years) after a successful initial ablation procedure are not infrequent, and repeat ablation procedures are often required to maintain freedom from symptomatic arrhythmias. Continued long-term follow-up of patients with PAF after initially successful ablation may be warranted, especially in those patients in whom anticoagulation is discontinued.

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

“…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.…”

Repeated Catheter Ablation of Atrial Fibrillation

“…after multiple procedures. 21 Patients with enlarged atria are at increased risk of late recurrence. 27 The importance of the size of LA, as a single independent predictor of success, 21,28 partly supports the concept of the critical mass hypothesis proposed by Moe 34 and verified by Damiano et al 35 The persistence of a cardiac substrate, that is potentially arrhythmogenic, can predispose to late recurrence.…”

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].…”