Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success

Schreiber, Doreen; Rostock, Thomas; Fröhlich, Max; Sultan, Arian; Servatius, Helge Simon; Hoffmann, Boris A; Lüker, Jakob; Berner, Imke; Schäffer, Benjamin; Wegscheider, Karl; Lezius, Susanne; Willems, Stephan; Steven, Daniel (2015). Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success. Circulation. Arrhythmia and electrophysiology, 8(2), pp. 308-317. Lippincott Williams & Wilkins 10.1161/CIRCEP.114.001672

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BACKGROUND

In the meantime, catheter ablation is widely used for the treatment of persistent atrial fibrillation (AF). There is a paucity of data about long-term outcomes. This study evaluates (1) 5-year single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after catheter ablation of persistent AF using the stepwise approach aiming at AF termination.

METHODS AND RESULTS

A total of 549 patients with persistent AF underwent de novo catheter ablation using the stepwise approach (2007-2009). A total of 493 patients were included (Holter ECGs ≥ every 6 months). Mean follow-up was 59 ± 16 months with 2.1 ± 1.1 procedures per patient. Single and multiple procedure success rates were 20.1% and 55.9%, respectively (80% off antiarrhythmic drug). Antiarrhythmic drug-free multiple procedure success was 46%. Long-term recurrences (n=171) were paroxysmal AF in 48 patients (28%) and persistent AF/atrial tachycardia in 123 patients (72%). Multivariable recurrent event analysis revealed the following factors favoring arrhythmia recurrence: failure to terminate AF during index procedure (hazard ratio [HR], 1.279; 95% confidence interval [CI], 1.093-1.497; P = 0.002), number of procedures (HR, 1.154; 95% CI, 1.051-1.267; P = 0.003), female sex (HR, 1.263; 95% CI, 1.027-1.553; P = 0.027), and the presence of structural heart disease (HR, 1.236; 95% CI, 1.003-1.524; P = 0.047). AF termination was correlated with a higher rate of consecutive procedures because of atrial tachycardia recurrences (P = 0.003; HR, 1.71; 95% CI, 1.20-2.43).

CONCLUSIONS

Catheter ablation of persistent AF using the stepwise approach provides limited long-term freedom of arrhythmias often requiring multiple procedures. AF termination, the number of procedures, sex, and the presence of structural heart disease correlate with outcome success. AF termination is associated with consecutive atrial tachycardia procedures.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Servatius, Helge Simon (A)

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1941-3084

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Helge Simon Servatius

Date Deposited:

15 Feb 2016 15:40

Last Modified:

29 Mar 2023 23:34

Publisher DOI:

10.1161/CIRCEP.114.001672

PubMed ID:

25744570

Uncontrolled Keywords:

arrhythmia (heart rhythm disorders); atrial fibrillation; catheter ablation; long-term outcome; stepwise approach; success

BORIS DOI:

10.7892/boris.75447

URI:

https://boris.unibe.ch/id/eprint/75447

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