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

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 1272 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%) repeat ablation. Patients with long-standing persistent AF presented with recurrent AT in 50% of the cases already before the first repeat ablation. At the end of 49 +/- 26 month follow-up, 83% of the patients remained in stable sinus rhythm (SR); 70% of the patients without antiarrhythmic drugs. SR maintenance was insignificantly superior in long-standing persistent AF group (91%) compared to paroxysmal 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. (C) 2012 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp.zo.o. All rights reserved.