Long-Term Outcome After Successful Catheter Ablation of Atrial Fibrillation

Abstract

Background-Pulmonary vein isolation (PVI) is increasingly used for treatment of atrial fibrillation (AF), but few reports exist regarding long-term success. We determined 5-year outcomes of PVI among patients with freedom from AF off antiarrhythmic drugs (AAD) for 1 year after PVI. Methods and Results-Consecutive patients with paroxysmal or persistent AF who underwent PVI at the University of Pennsylvania from 2000 to 2003 and were free from AF 1 year after ablation were included. Proximal isolation of PVs and non-PV triggers of AF was performed. Long-term ablation success, defined as freedom from AF off AAD after a single ablation procedure, was determined. All patients had transtelephonic monitoring at 3 to 6 months and 12 months and at least yearly contact thereafter. One hundred twenty-three patients were free of AF without AAD at 1 year. AF freedom off AAD was 85% at 3 years and 71% at 5 years, with an approximate 7% per year late recurrence rate after the first year. Patients with recurrent AF Ն5 years after index PVI were older, had larger left atrial size, more AF triggers and more likely had persistent AF. In multivariate analysis, persistent AF (odds ratio, 2.8; 95% confidence interval, 1.4 to 5.7, Pϭ0.005) and age (odds ratio, 1.1; 95% confidence interval, 1.0 to 1.1, Pϭ0.036) independently predicted long-term AF recurrence. Conclusions-Among patients with paroxysmal or persistent AF and AF freedom 1 year after segmental PVI, the majority (71%) remained free of AF for up to 5 years, with an approximate late recurrence rate of 7% per year. Continued vigilance for recurrent AF after PV isolation is warranted, particularly in patients with persistent AF. (Circ Arrhythm Electrophysiol. 2010;3:237-242.)

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

“…39 Importantly, the rate of freedom from AF in the conventional PVI group was lower than would be expected based on other contemporary series. 40 The authors then retrospectively analysed computational AF maps in the patients who underwent only conventional PVI to determine the location of rotors and focal impulses in these patients and to see if ablation lesions performed blindly as part of the conventional PVI procedure coincidently eliminated these sources. When conventional PVI coincidently eliminated a rotor or focal impulse, freedom from AF during follow-up was four-fold higher than in patients in whom AF drivers were not eliminated (80.3 % vs. 18.2 %, p<0.001).…”

Predictors of atrial fibrillation recurrence after atrial fibrillation ablation with cryoballoon

“…It was shown that age was a strong predictor of AF recurrence in patients with maze procedure and RF AF ablation [22][23][24][25]. Ageing leads to interstitial fibrosis and more extensive LA remodeling; therefore it increases the likelihood of additional AF triggers, which may predispose to recurrent AF after limited ablation.…”

Anticoagulation after Atrial Fibrillation Ablation: Many Blanks to Fill

“…5 In this study, of the selected patients with successful outcome of a single ablation at 1 year, only 85% remained in stable SR after 3 years, and even only 71% after 5 years, showing approximately 7% per year late AF recurrence. This does not inevitably mean that anticoagulation should be maintained indiscriminately in all the patients because of doubts about the ablation efficacy.…”