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Long-Term Outcome of Atrial Fibrillation Ablation: Impact and Predictors of Very Late Recurrence

Authors


  • This study is funded by the Mayo Clinician Investigator Award to DL Packer.

  • Dr. Asirvatham receives honoraria from Boston Scientific, St. Jude Medical, Biotronik, and Medtronic and serves as a consultant for Sanofi-Aventis. Dr. Friedman receives research funding from Bard, St. Jude Medical, Medtronic, Boston Scientific, and Pfizer; intellectual property rights for Bard EP, Hewlett Packard, Medical Positioning, Inc., Aegis Medical, and NeoChord; and has served as a speaker/consultant for Medtronic, Boston Scientific, and St. Jude Medical. Dr. Packer in the past 12 months has provided consulting services for Biosense Webster, Inc., Boston Scientific, CyberHeart, Medtronic, Inc., nContact, Sanofi-Aventis, St. Jude Medical, and Toray Industries. Dr. Packer received no personal compensation for these consulting activities. Dr. Packer receives research funding from the NIH, Medtronic, Inc., CryoCath, Siemens AG, EP Limited, St. Jude Medical, Minnesota Partnership for Biotechnology and Medical Genomics/ University of Minnesota, Biosense Webster, Inc. and Boston Scientific. Mayo Clinic and Drs. Packer and R. Robb (not a contributing author) have a financial interest in mapping technology. In accordance with the Bayh-Dole Act, this technology has been licensed to St. Jude Medical, and Mayo Clinic and Drs. Packer and Robb have received annual royalties greater than $10,000, the federal threshold for significant financial interest. Other authors report no potential conflicts.

Address for correspondence: Douglas L. Packer, M.D., Mayo Clinic, St. Mary's Hospital, 1216 2nd St SW, AL 2-416, Rochester, MN 55902, USA. Fax: +1-507-255-3292; E-mail: packer@mayo.edu

Abstract

Long-Term Outcome of AF Ablation. Introduction: 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.

Methods and Results: 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], P < 0.001). 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 size >45 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.

Conclusion: Late recurrences reduced the long-term efficacy of AF ablation, particularly in patients with PersAF and underlying cardiovascular diseases. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1071-1078)

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