Long-term outcome of radiofrequency catheter ablation for persistent atrial fibrillation

Abstract

Catheter ablation has been wildly used to treat atrial fibrillation (AF) and has achieved a better efficacy for paroxysmal AF (PAF) but not for persistent AF (PerAF). Furthermore, a few data on the efficacy and safety of catheter ablation for PerAF were reported. This study aimed to investigate long-term efficacy of radiofrequency catheter ablation (RFCA) for PerAF and explore predictors of late recurrence of atrial fibrillation (LRAF).A total of 92 consecutive patients with PerAF (64 males, aged 56.42 ± 11.24 years) were enrolled in this study and accepted circumferential pulmonary vein isolation (CPVI) alone or CPVI combined additional ablation.Maintenance rate of sinus rhythm (SR) was 40.2% after a single procedure with median follow-up of 15 months and 52.2% after mean 1.3 ± 0.6 procedures with median follow-up of 26 months. Long-term SR maintenance rate was no statistical difference between patients with CPVI alone and with CPVI combined additional ablation (48.6% vs 35.1%, log rank test, P = .152). Patients with AF duration < 24 months had a higher long-term SR maintenance rate than those with AF duration ≥ 24 months (55.6% vs 30.4%, log rank test, P = .022). AF duration (OR = 1.015, 95%CI 1.001–1.030, P = .015), and early recurrence of AF (ERAF) (OR = 10.654, 95%CI 3.853–29.460, P < .001) were predictors of LRAF after a single procedure.In conclusion, long-term maintenance SR rate was 52.2% in patients with PerAF after multiple procedures with a median over 2-year follow-up. Patients with AF duration < 24 months had better outcome. AF duration and ERAF were predictors of LRAF after a single procedure.

Ablation in Atrial Fibrillation with Ventricular Pacing Results in Similar Catheter Stability and Arrhythmia Recurrence Compared to Ablation in Sinus Rhythm with Atrial Pacing

“…Overall one year arrhythmia-free survival was 73%, which is in line with previous data for persistent AF ablation 4,6,7 and there was no significant difference in recurrence between the atrial-paced and ventricularpaced patients. The ventricular-paced patients had significantly greater LA diameters, time since AF diagnosis, as well as trend toward greater LA volume indices and lower LV ejection fraction.…”

“…However, ablation of persistent atrial fibrillation remains a therapeutic challenge, with recurrence rates of 30-60% at one year, and a frequent need for repeat ablation. [4][5][6][7] Improved catheter stability results in more consistent catheter-tissue contact, both allowing for more effective transmural lesion formation and preventing excessive force that could result in cardiac perforation. Furthermore, improved catheter stability has been shown to be associated with decreased arrhythmia recurrence following AF ablation.…”

Epicardial adipose tissue and atrial fibrillation: Possible mechanisms, potential therapies, and future directions

“…With current incidence of approximately 1%, AF is affecting more population globally without satisfactory therapy . Radiofrequency catheter ablation (RFCA) is proved comparatively effective, nevertheless, unnegligible AF recurrence, and possible severe complication limited the application of RFCA . In order to develop effective therapies for AF, it is necessary to explore exact mechanism of AF.…”

Designing an Efficient and Quality-focused Integrated Atrial Fibrillation Care Center

“…AF ablation has the highest success rate when the procedure is performed <24 months after initial symptoms. 22 Therefore, delays in specialized evaluation and care can impact not only patient outcomes but also hospital and overall health care costs. Patients with recurrent symptomatic AF may be more likely to have additional emergency department visits, hospital admissions, and health care utilization while waiting to be seen by an electrophysiologist.…”