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

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 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.