Cor Vasa 2012, 54(11-12):e361-e368 | DOI: 10.1016/j.crvasa.2012.10.006

Long-term results of catheter ablation for atrial fibrillation in 866 patients

Martin Fiala^a,b,*, Libor Škňouřil^a, Ondřej Toman^b, Jakub Pindor^a, Veronika Bulková^a, Jan Chovančík^a, Radek Neuwirth^a, Růžena Lábrová^b, Jaroslav Januška^a, Jindřich Špinar^b

^a Oddělení kardiologie, Kardiocentrum, Nemocnice Podlesí, a. s., Třinec, Česká republika

^b Interní kardiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika

Purpose: This study presents eight-year experience with ablation techniques, recurrent arrhythmias, and long-term outcomes in patients undergoing catheter ablation for atrial fibrillation (AF).

Methods: Catheter ablation of AF was performed in 866 consecutive patients in a total of 1,272 ablation procedures. Ablation strategy and procedure endpoints were left at the operator's discretion. Total study population and groups of paroxysmal (n = 508/59%), persistent (n = 102/12%), and long-standing persistent AF (n = 256/29%) were evaluated.

Results: Pulmonary vein isolation alone or with cavo-tricuspid isthmus ablation was accomplished in 36% of the patients. It was significantly more often used in paroxysmal AF than in persistent or long-standing persistent AF (both p < 0.001). More extensive ablation prevailed in persistent AF types. Ablation was repeated in 307 (35%) patients. Patients with long-standing persistent AF underwent significantly more repeat procedures than patients with paroxysmal AF (p < 0.001) or persistent AF (p = 0.001). Recurrent AF dominated before the first repeat ablation in 68% cases, while recurrent atrial tachycardia (AT) prevailed before the second (73%), and third (93%) re-peat ablation. Patients with long-standing persistent AF presented with recurrent AT in 50% of the cases alrea-dy before the first repeat ablation. At the end of 49 ± 26 months follow-up, 83% of the patients remained in stab-le sinus rhythm (SR); 70% of the patients without antiarrhythmic drugs. SR maintenance was insignificantly superior in long-standing persistent AF group (91%) compared to paroxys-mal AF (82%) and persistent AF patients- (68%).

Conclusion: Patients with persistent AF types underwent more extensive initial ablation. Patients with long-standing persistent AF experienced best long-term outcome likely as a consequence of higher number of repeat ablation procedures.

Keywords: Atrial fibrillation; Catheter ablation; Outcome; Recurrent arrhythmias

Received: September 23, 2012; Revised: October 30, 2012; Accepted: October 31, 2012; Published: November 1, 2012  Show citation