Catheter Ablation of Long-Standing Persistent Atrial Fibrillation: 5-Year Outcomes of the Hamburg Sequential Ablation Strategy

Study Questions:

What is the long-term efficacy of radiofrequency catheter ablation (RFCA) of long-standing persistent atrial fibrillation (LSPAF)?

Methods:

RFCA was performed in 202 patients (mean age 61 years) with LSPAF (median duration 36 months). The ablation strategy included circumferential pulmonary vein isolation (PVI) in all patients. Ablation of nonpulmonary vein triggers and/or complex fractionated atrial electrograms and/or linear ablation were performed on an individualized basis. A 24-hour Holter recording was obtained at 1, 3, and 6 months post-ablation, and every 6 months thereafter. Clinical success was defined as freedom from AF recurrence during follow-up. Regression of LSPAF was defined as conversion to paroxysmal AF or maintenance of sinus rhythm during antiarrhythmic drug (AAD) therapy.

Results:

During a median follow-up of 56 months after the first procedure, LSPAF recurred in 161/202 patients (80%). With AAD therapy, there was regression of LSPAF in 36/161 patients (22%). A median of two RFCA procedures was performed. During a median of 50 months of follow-up after the final procedure, 45% of patients were free of AF, and 23% had regression of LSPAF on AAD therapy. Independent predictors of AF recurrence were AF duration >2 years and PVI as the sole ablation strategy.

Conclusions:

The authors concluded that the long-term efficacy of RFCA of LSPAF is 45%.

Perspective:

Of note is that patients with a total AF duration >2 years were approximately 3 times more likely to have recurrent AF after RFCA. The most likely explanation for this is long-term structural and electrical remodeling that predisposes to recurrent AF. These results strengthen the case for early intervention in patients with persistent AF who are appropriate candidates for catheter ablation.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise

Keywords: Early Intervention (Education), Recurrence, Follow-Up Studies, Exercise, Pulmonary Veins, Atrial Remodeling, Electrophysiologic Techniques, Cardiac, Catheter Ablation, Atrial Flutter


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