Long-term results of catheter ablation for atrial fibrillation in 866 patients

Abstract

Purpose: This study presents eight-year experience with ablation techniques, recurrent arrhythmias, and long-term outcomes in patients undergoing catheter ablation for atrial fi brillation (AF). Methods: Catheter ablation of AF was performed in 866 consecutive patients in a total of 1,272 ablation procedures. Ablation strategy and procedure endpoints were left at the operator's discretion. Total study population and groups of paroxysmal (n = 508/59%), persistent (n = 102/12%), and long-standing persistent AF (n = 256/29%) were evaluated. Results: Pulmonary vein isolation alone or with cavo-tricuspid isthmus ablation was accomplished in 36% of the patients. It was signifi cantly more often used in paroxysmal AF than in persistent or long-standing persistent AF (both p < 0.001). More extensive ablation prevailed in persistent AF types. Ablation was repeated in 307 (35%) patients. Patients with long-standing persistent AF underwent signifi cantly more repeat procedures than patients with paroxysmal AF (p < 0.001) or persistent AF (p = 0.001). Recurrent AF dominated before the fi rst repeat ablation in 68% cases, while recurrent atrial tachycardia (AT) prevailed before the second (73%), and third (93%) re peat ablation. Patients with long-standing persistent AF presented with recurrent AT in 50% of the cases alrea dy before the fi rst repeat ablation. At the end of 49 ± 26 months follow-up, 83% of the patients remained in stab le sinus rhythm (SR); 70% of the patients without antiarrhythmic drugs. SR maintenance was insignifi cantly superior in long-standing persistent AF group (91%) compared to paroxysmal AF (82%) and persistent AF patients (68%). Conclusion: Patients with persistent AF types underwent more extensive initial ablation. Patients with long--standing persistent AF experienced best long-term outcome likely as a consequence of higher number of repeat ablation procedures. SOUHRNCíl: Tato studie analyzovala osmileté zkušenosti s ablačními technikami, recidivujícími arytmiemi a dlouhodobými výsledky u pacientů, kteří podstoupili katetrovou ablaci pro fi brilaci síní (FS). Metodika: Katetrovou ablaci FS podstoupilo 866 konsekutivních pacientů v celkovém počtu 1 272 výkonů. Ablační strategie a cílové momenty výkonu byly individuální podle rozhodnutí operatéra. Hodnotily se výsledky v celém souboru a ve skupinách paroxysmální (n = 508/59 %), perzistentní (n = 102/12 %) a dlouhodobé perzistentní FS (n = 256/29 %). Výsledky: Izolace plicních žil samotná nebo spojená s ablací kavotrikuspidálního můstku byla provedena u 36 % pacientů. Častěji byla použita u pacientů s paroxysmální FS než u pacientů s perzistentní nebo dlouhodobou perzistentní FS (obě p < 0,001). Naopak rozsáhlejší ablace převažovala u pacientů s perzis-

Two-staged hybrid treatment of persistent atrial fibrillation: short-term single-centre results

“…The success rate of catheter ablation in patients with persistent or long-lasting persistent AF, where fibrotic alteration of the atrial wall and enlargement of the LA is usually present, is reported to be as low as 45% after a single procedure. Even after redo ablation the success rate does not exceed 60% after 1 year and decreases quickly with time [5][6][7][8].…”

“…Catheter ablation as a first-line treatment for patients with drug-refractory AF has variable results with single-procedure success rates ranging from 16 to 84% [4]. Success rate decreases with the necessity for repeat procedures and higher economic costs in persistent forms of AF [5][6][7][8]. In these patients, the left atrium is often enlarged with fibrotic remodelling and the transvenous endocardial approach and creation of linear lesions is sometimes challenging.…”