1. Long-term outcome of atrial fibrillation ablation: impact and predictors of very late recurrence
- Author
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M R N Christine Bluhm, Stephen C. Hammill, Paul A. Friedman, Anita Wokhlu, Thomas M. Munger, Win-Kuang Shen, H R N Kristi Monahan, Samuel J. Asirvatham, David O. Hodge, Peter A. Brady, Yong-Mei Cha, M R N Janis Haroldson, and Douglas L. Packer
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Minnesota ,Catheter ablation ,Risk Assessment ,Pulmonary vein ,Recurrence ,Risk Factors ,Physiology (medical) ,Diabetes mellitus ,Internal medicine ,Late Recurrence ,Atrial Fibrillation ,Prevalence ,Medicine ,Humans ,In patient ,Longitudinal Studies ,Initial rate ,business.industry ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Treatment Outcome ,Cardiology ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Ablation eliminates atrial fibrillation (AF) in studies with 1 year follow-up, but very late recurrences may compromise long-term efficacy. In a large cohort, we sought to describe the determinants of delayed recurrence after AF ablation.Seven hundred and seventy-four patients with AF (428 paroxysmal [PAF, 55%] and 346 persistent or longstanding persistent [PersAF, 45%]) underwent wide area circumferential ablation (WACA, 62%) or pulmonary vein isolation (38%). Over 3.0 ± 1.9 years, there were 135 recurrences in PAF patients and 142 in PersAF patients. AF elimination was achieved in 61% of patients with PersAF at 2 years after last ablation and in 71% of patients with PAF (P = 0.04). This finding was related to a higher initial rate of very late recurrence in PersAF. From 1.0 to 2.5 years, the recurrence increased by 20% (from 37% to 57%) in PersAF patients versus only 12% (from 27% to 39%) in PAF patients. Independent predictors of overall recurrence included diabetes (HR 1.9 [1.3-2.9], P = 0.002) and PersAF (HR 1.6 [1.2-2.0], P0.001). Independent predictors of very late recurrence included PersAF (HR 1.7 [1.1-2.7], P = 0.018) and WACA (HR 1.8 [1.1-2.7], P = 0.018), while diabetes came close to significance. In PAF patients, left atrial size45 mm was identified as an AF-type specific predictor (HR 2.4 [1.3-4.7], P = 0.009), whereas in PersAF patients, no unique predictors were identified.Late recurrences reduced the long-term efficacy of AF ablation, particularly in patients with PersAF and underlying cardiovascular diseases.
- Published
- 2010