Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint.

Scherr, Daniel; Khairy, Paul; Miyazaki, Shinsuke; Aurillac-Lavignolle, Valérie; Pascale, Patrizio; Wilton, Stephen B; Ramoul, Khaled; Komatsu, Yuki; Roten, Laurent; Jadidi, Amir; Linton, Nick; Pedersen, Michala; Daly, Matthew; O'Neill, Mark; Knecht, Sébastien; Weerasooriya, Rukshen; Rostock, Thomas; Manninger, Martin; Cochet, Hubert; Shah, Ashok J; ... (2015). Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint. Circulation. Arrhythmia and electrophysiology, 8(1), pp. 18-24. Lippincott Williams & Wilkins 10.1161/CIRCEP.114.001943

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BACKGROUND -This study aimed to determine five-year efficacy of catheter ablation for persistent atrial fibrillation (PsAF) using AF termination as a procedural endpoint. METHODS AND RESULTS -150 patients (57±10 years) underwent PsAF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided and linear ablation) with the desired procedural endpoint being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia (AT). AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3±3.9%, 28.0±3.7%, and 16.8±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7±2.5%, 79.8±3.4%, and 62.9±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (IQR 43-73) months following the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs (AADs). Another 14 (9.3%) patients maintained sinus rhythm after re-initiation of AADs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (HR 3.831; 95%CI: 2.070-7.143; p<0.001), left atrial diameter ≥50mm (HR 2.083; 95%CI: 1.078-4.016; p=0.03), continuous AF duration ≥18 months (HR 1.984; 95%CI: 1.024-3.846; p<0.04) and structural heart disease (HR 1.874; 95% CI: 1.037-3.388; p=0.04) predicted arrhythmia recurrence. CONCLUSIONS -In patients with PsAF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow up period.Procedural AF non-termination and specific baseline factors predict long-term outcome after ablation.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Roten, Laurent

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1941-3084

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Laurent Roten

Date Deposited:

10 Feb 2015 08:30

Last Modified:

19 Nov 2015 10:39

Publisher DOI:

10.1161/CIRCEP.114.001943

PubMed ID:

25528745

Uncontrolled Keywords:

ablation, atrial fibrillation, atrial tachycardia

BORIS DOI:

10.7892/boris.62772

URI:

https://boris.unibe.ch/id/eprint/62772

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