Five-Year Outcome Following the Sequential Approach in Patients with Long-Standing-Persistent Atrial Fibrillation

概要

論文の詳細を見る
Background: Long-term outcome of >2 years following catheter ablation for longstanding persistent atrial fibrillation (LS-AF) is very limited. We evaluated the five-year efficacy of catheter ablation for LS-AF. Methods: Follow-up was performed in 202 patients (age 61±9 years; 160 male) who underwent catheter ablation for symptomatic LS-AF. Circumferential pulmonary vein isolation (CPVI) was the first line ablative treatment. Additional ablation was only performed if DC cardioversion failed after CPVI. Median follow-up duration was 56.3 (IQR; 49.1; 66.8) months. After index procedure stable SR was documented in 41/202 (20.3%) patients. Following multiple procedures, stable SR remained in 91/202 (45.0%) patients including 24 (26.4%) on antiarrhythmic drugs. CPVI was the sole ablative therapy in 105 patients. Fifty out of these 105 (47.6%) patients remained in sinus rhythm. Solely the total AF duration and the sustained AF duration could be identified as a predictor of recurrence. Each additional year of sustained AF increases the risk for arrhythmia recurrence by 7.4% (HR 1.074%, [95% CI, 1.037 to 1.127]; p=0.0003). Conclusions: In patients with LS-AF, single procedure success is poor during 5 years follow-up. CPVI alone is sufficient to restore SR in 25% of patients with LS-AF. Repeat ablation and additional ablation strategies are often required to maintain sinus-rhythm in 45%.