Ablation for persistent atrial fibrillation achieved stable sinus rhythm in 25% of patients after a single procedure and 68% after multiple procedures over a median 89-month follow-up.
Observational (n=174)
Does circumferential pulmonary vein isolation (CPVI) with or without additional ablation improve stable sinus rhythm in patients with persistent atrial fibrillation?
Long-term follow-up of persistent AF ablation demonstrates that while single-procedure success is modest, multiple procedures yield good rates of stable sinus rhythm, which is primarily predicted by a shorter duration of persistent AF prior to ablation.
Effect estimate: HR 1.608 (95% CI 1.034-1.103)
p-value: p=<0.001
INTRODUCTION: Ablation of persistent atrial fibrillation (AF) is a potential treatment option for symptomatic patients. We sought to evaluate the critical role of circumferential pulmonary vein isolation (CPVI) in the ablation of persistent AF. METHODS AND RESULTS: A total of 341 ablation procedures were performed in 174 consecutive patients with persistent AF. CPVI was performed in all patients, additional ablation was only performed if electrical cardioversion failed after CPVI. During a median follow-up (FU) of 89 (63; 89) months, stable sinus rhythm was documented in 42/170 (25%) patients after a single procedure and in 111/164 (68%) patients after 1.9 ± 1.1 procedures. Stable SR was achieved in 40/75 (53%) patients in whom only CPVI was performed during the index and repeat procedures and in 71/89 (79%) patients with CPVI plus additional ablation. The main predictor for ablation success was duration of persistent AF before the index procedure (P < 0.001, HR ± CI: 1.608 1.034, 1.103). Responders to CPVI during the initial procedure had a significantly better multiple-procedure outcome after 42 months of FU compared to CPVI nonresponders (P = 0.0365). Conversion during the index procedure had no impact on clinical outcomes (P = 0.0903). Persistent AF regressed to paroxysmal AF in 16% of patients. CONCLUSIONS: We demonstrate a 25% single- and 68% multiple-procedure success in patients with persistent AF, while stable SR was achieved in 53% of patients with pure CPVI during all procedures and in 79% of patients with CPVI plus additional ablation. Only duration of persistent AF before ablation had a statistically significant impact on ablation outcome.
Brooks et al. (Thu,) conducted a observational in persistent atrial fibrillation (n=174). Circumferential pulmonary vein isolation (CPVI) with or without additional ablation was evaluated on Stable sinus rhythm after multiple procedures (HR 1.608, 95% CI 1.034-1.103, p=<0.001). Ablation for persistent atrial fibrillation achieved stable sinus rhythm in 25% of patients after a single procedure and 68% after multiple procedures over a median 89-month follow-up.
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