Six Year Follow-Up After Catheter Ablation of Atrial Fibrillation: A Palliation More Than a True Cure
What are the long-term results of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?
In this retrospective study, 103 patients (mean age 53 years) underwent RFCA of AF (nonparoxysmal in 61%) and were followed for ≥4 years (median follow-up 6 years). All patients underwent pulmonary vein (PV) isolation. Additional ablation was performed at the operator’s discretion if AF or atrial tachycardia (AT) was inducible by rapid pacing. Long-term follow-up consisted of periodic Holter or continuous loop monitoring and clinic visit at least once a year.
AF/AT recurred in 80/103 patients (78%) after the first procedure. A second procedure was performed in 42 patients and a third procedure was performed in 7 patients. The incidence of freedom from AF/AT was 63% at 1 year, 53% at 2 years, 45% at 4 years, and 39% at 6 years. The strongest predictor of recurrent AF/AT was nonparoxysmal AF. There was freedom from AF/AT at 6 years in 50% of patients with paroxysmal AF compared to 31% of patients with nonparoxysmal AF.
In approximately two-thirds of patients with recurrent AF/AT after RFCA of AF, the arrhythmia recurs during the first year of follow-up. AF/AT continues to recur during subsequent years of follow-up.
The study confirms that the recurrence rate of AF/AT late after RFCA of AF is in the range of 5-10%/year. Delayed reconnection of the PVs probably is the major reason for late recurrence of AF/AT in patients with paroxysmal AF. In patients with persistent AF, contributing factors include PV reconnection, ongoing left atrial remodeling, and underlying comorbidities such as obesity, sleep apnea, and hypertension.
Keywords: Follow-Up Studies, Atrial Fibrillation, Catheter Ablation, Hypertension
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