Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up?
Rukshen Weerasooriya, Paul Khairy, Jean Litalien, Laurent Macle, Meleze Hocini, Frederic Sacher, Nicolas Lellouche, Sebastien Knecht, Matthew Wright, Isabelle Nault, Shinsuke Miyazaki, Christophe Scavee, Jacques Clementy, Michel Haissaguerre, Pierre Jais, Rukshen Weerasooriya, Paul Khairy, Jean Litalien, Laurent Macle, Meleze Hocini, Frederic Sacher, Nicolas Lellouche, Sebastien Knecht, Matthew Wright, Isabelle Nault, Shinsuke Miyazaki, Christophe Scavee, Jacques Clementy, Michel Haissaguerre, Pierre Jais
Abstract
Objectives: This study describes 5-year follow-up results of catheter ablation for atrial fibrillation (AF).
Background: Long-term efficacy following catheter ablation of AF remains unknown.
Methods: A total of 100 patients (86 men, 14 women), age 55.7 ± 9.6 years, referred to our center for a first AF ablation (63% paroxysmal; 3.5 ± 1.4 prior ineffective antiarrhythmic agents) were followed for 5 years. Complete success was defined as absence of any AF or atrial tachycardia recurrence (clinical or by 24-h Holter monitoring) lasting ≥ 30 s.
Results: Arrhythmia-free survival rates after a single catheter ablation procedure were 40%, 37%, and 29% at 1, 2, and 5 years, respectively, with most recurrences over the first 6 months. Patients with long-standing persistent AF experienced a higher recurrence rate than those with paroxysmal or persistent forms (hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.0 to 3.5; p = 0.0462). In all, 175 procedures were performed, with a median of 2 per patient. Arrhythmia-free survival following the last catheter ablation procedure was 87%, 81%, and 63% at 1, 2, and 5 years, respectively. Valvular heart disease (HR: 6.0, 95% CI: 2.0 to 17.6; p = 0.0012) and nonischemic dilated cardiomyopathy (HR: 34.0, 95% CI: 6.3 to 182.1; p < 0.0001) independently predicted recurrences. Major complications (cardiac tamponade requiring drainage) occurred in 3 patients (3%).
Conclusions: In selected patients with AF, a catheter ablation strategy with repeat intervention as necessary provides acceptable long-term relief. Although most recurrences transpire over the first 6 to 12 months, a slow but steady decline in arrhythmia-free survival is noted thereafter.
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed