Long-term outcome after successful catheter ablation of atrial fibrillation.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101474365 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-3084 (Electronic) Linking ISSN: 19413084 NLM ISO Abbreviation: Circ Arrhythm Electrophysiol Subsets: MEDLINE

Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins

Catheter Ablation*; Atrial Fibrillation/*surgery ; Pulmonary Veins/*surgery; Adult ; Age Factors ; Aged ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Electrocardiography ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Pennsylvania ; Proportional Hazards Models ; Pulmonary Veins/physiopathology ; Recurrence ; Risk Assessment ; Risk Factors ; Telemetry ; Time Factors ; Treatment Outcome

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 >or=5 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, P=0.005) and age (odds ratio, 1.1; 95% confidence interval, 1.0 to 1.1, P=0.036) 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.

Date Created: 20100326 Date Completed: 20100709 Latest Revision: 20230815

20240513

10.1161/CIRCEP.109.923771

20335557