Stepwise catheter ablation for nonparoxysmal atrial fibrillation yielded a long-term recurrence-free rate of only 28.4% after a single procedure over a median 36.8 months of follow-up.
Cohort (n=88)
What is the long-term recurrence-free rate of stepwise catheter ablation in patients with nonparoxysmal atrial fibrillation?
The long-term success rate of a single catheter ablation procedure for nonparoxysmal atrial fibrillation is low (28.4%), often requiring multiple procedures to achieve freedom from recurrence, with higher CHADS2 scores and larger left atrial dimensions predicting failure.
BACKGROUND: Catheter ablation of atrial fibrillation (AF) became an effective therapy for patients with drug-refractory AF, and the indications have broadened to include nonparoxysmal AF patients. However, data about the long-term effectiveness of ablation in patients with nonparoxysmal AF are lacking. The aim of the present study was to investigate the long-term outcomes of catheter ablation in patients with nonparoxysmal AF. METHODS AND RESULTS: A total of 88 nonparoxysmal AF patients who received a stepwise catheter ablation (isolation of the pulmonary veins plus substrate modification) from 2006 to 2008 were enrolled. Freedom of recurrence was defined as the absence of atrial arrhythmias without using any antiarrhythmic agents after the catheter ablation. There were 63 patients (71.6%) with recurrences (47 patients with AF and 16 patients with atrial flutter/atrial tachycardia) after the initial procedure during a median follow-up period of 36.8 months. A CHADS2 score of ≥3 and the left atrial (LA) diameter were significant predictors of recurrences in the multivariable analysis. Of the patients with CHADS2 scores of ≥3 and an LA dimension≥44 mm, all had recurrences within 1 year after the initial procedure. The overall recurrence-free rate could increase to 47.7% after the second procedure and 51.1% after the third procedure. CONCLUSIONS: The long-term recurrence-free rate of ablation in nonparoxysmal AF was only 28.4% after a single procedure, and multiple procedures were necessary to raise the recurrence-free rate. The CHADS2 score and LA dimension may help us to identify patients who will have recurrences after catheter ablations of nonparoxysmal AF.
Chao et al. (Wed,) conducted a cohort in Nonparoxysmal Atrial Fibrillation (n=88). Stepwise catheter ablation (isolation of the pulmonary veins plus substrate modification) was evaluated on Freedom of recurrence (absence of atrial arrhythmias without using any antiarrhythmic agents). Stepwise catheter ablation for nonparoxysmal atrial fibrillation yielded a long-term recurrence-free rate of only 28.4% after a single procedure over a median 36.8 months of follow-up.
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