Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis

Anand N Ganesan, Nicholas J Shipp, Anthony G Brooks, Pawel Kuklik, Dennis H Lau, Han S Lim, Thomas Sullivan, Kurt C Roberts-Thomson, Prashanthan Sanders, Anand N Ganesan, Nicholas J Shipp, Anthony G Brooks, Pawel Kuklik, Dennis H Lau, Han S Lim, Thomas Sullivan, Kurt C Roberts-Thomson, Prashanthan Sanders

Abstract

Background: In the past decade, catheter ablation has become an established therapy for symptomatic atrial fibrillation (AF). Until very recently, few data have been available to guide the clinical community on the outcomes of AF ablation at ≥3 years of follow-up. We aimed to systematically review the medical literature to evaluate the long-term outcomes of AF ablation.

Methods and results: A structured electronic database search (PubMed, Embase, Web of Science, Cochrane) of the scientific literature was performed for studies describing outcomes at ≥3 years after AF ablation, with a mean follow-up of ≥24 months after the index procedure. The following data were extracted: (1) single-procedure success, (2) multiple-procedure success, and (3) requirement for repeat procedures. Data were extracted from 19 studies, including 6167 patients undergoing AF ablation. Single-procedure freedom from atrial arrhythmia at long-term follow-up was 53.1% (95% CI 46.2% to 60.0%) overall, 54.1% (95% CI 44.4% to 63.4%) in paroxysmal AF, and 41.8% (95% CI 25.2% to 60.5%) in nonparoxysmal AF. Substantial heterogeneity (I(2)>50%) was noted for single-procedure outcomes. With multiple procedures, the long-term success rate was 79.8% (95% CI 75.0% to 83.8%) overall, with significant heterogeneity (I(2)>50%).The average number of procedures per patient was 1.51 (95% CI 1.36 to 1.67).

Conclusions: Catheter ablation is an effective and durable long-term therapeutic strategy for some AF patients. Although significant heterogeneity is seen with single procedures, long-term freedom from atrial arrhythmia can be achieved in some patients, but multiple procedures may be required.

Figures

Figure 1.
Figure 1.
Search criteria and flow diagram for studies included in this systematic review. AF indicates atrial fibrillation; SVT, supraventricular tachycardia; AV, atrioventricular; CRT, cardiac resynchronization therapy; RA, right atrial.
Figure 2.
Figure 2.
Single‐procedure success at 12 months postprocedure (A) and at late follow‐up (B). AF indicates atrial fibrillation.
Figure 3.
Figure 3.
Multiple late procedure success, defined as the cumulative arrhythmia‐free survival at ≥3 years. AF indicates atrial fibrillation.
Figure 4.
Figure 4.
A, Annualized single‐ and multiple‐ procedure arrhythmia‐free success were calculated (subtable number of studies at each year after ablation). B, Annualized PAF and NPAF single‐procedure arrhythmia‐free success were calculated (subtable number of studies at each year after ablation). Meta‐analysis for NPAF was not performed beyond 4 years, because only 2 studies reported at this duration of follow‐up. PAF indicates paroxysmal atrial fibrillation; NPAF, nonparoxysmal atrial fibrillation.

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