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Catheter Ablation for Atrial Fibrillation: Are Results Maintained at 5 Years of Follow-Up?
Study Questions:
What is the long-term efficacy of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?
Methods:
One hundred patients (mean age 56 years) with AF (paroxysmal in 64 and persistent in 36) underwent pulmonary vein isolation and ablation of the cavotricuspid isthmus plus linear RFCA along the left atrial roof and mitral isthmus as indicated. Serial 24-hour Holter monitoring was performed during the first year of follow-up and again at ≥5 years of follow-up.
Results:
The median number of RFCA procedures was two, and the median follow-up was 60 months. Arrhythmia-free survival rates after a single ablation procedure were 39.8% and 28.5% at 1 and 5 years of follow-up, respectively. AF recurred in 28% of patients who had been AF-free for ≥1 year. After ≥1 redo procedure, the arrhythmia-free survival rates were 87% and 67% at 1 and 5 years of follow-up, respectively, and AF recurred in 25% of patients who had been AF-free for ≥1 year. The AF recurrence rate after redo procedures was 8.9%/year. The independent predictors of recurrent AF were valvular heart disease (hazard ratio [HR], 6) and nonischemic cardiomyopathy (HR, 34).
Conclusions:
There is a steady decline in arrhythmia-free survival of approximately 10%/year after RFCA of AF.
Perspective:
Recurrences of AF within the first few months after RFCA most often are due to inadequate pulmonary vein isolation or some other deficiency in the RFCA strategy. On the other hand, late recurrences may result from factors outside the electrophysiology laboratory that continue to predispose to recurrent AF, such as obesity, sleep apnea, hypertension, other comorbidities, or genetic factors.
Keywords: Electrophysiology, Recurrence, Heart Atria, Follow-Up Studies, Survival Rate, Cardiomyopathies, Pulmonary Veins, Heart Valve Diseases, Electrocardiography, Ambulatory, Catheter Ablation, Hypertension
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