Long-term outcome of atrial fibrillation ablation: Impact and predictors of very late recurrence

Anita Wokhlu, David O. Hodge, Kristi H. Monahan, Samuel J Asirvatham, Paul Andrew Friedman, Thomas M. Munger, Yong-Mei Cha, Win Kuang Shen, Peter A. Brady, Christine M. Bluhm, Janis M. Haroldson, Stephen C. Hammill, Douglas L Packer

Research output: Contribution to journalArticle

121 Citations (Scopus)

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)

Original languageEnglish (US)
Pages (from-to)1071-1078
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume21
Issue number10
DOIs
StatePublished - Oct 2010

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Atrial Fibrillation
Recurrence
Pulmonary Veins
Cardiovascular Diseases

Keywords

  • atrial fibrillation
  • catheter ablation
  • diabetes
  • late recurrence pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Long-term outcome of atrial fibrillation ablation : Impact and predictors of very late recurrence. / Wokhlu, Anita; Hodge, David O.; Monahan, Kristi H.; Asirvatham, Samuel J; Friedman, Paul Andrew; Munger, Thomas M.; Cha, Yong-Mei; Shen, Win Kuang; Brady, Peter A.; Bluhm, Christine M.; Haroldson, Janis M.; Hammill, Stephen C.; Packer, Douglas L.

In: Journal of Cardiovascular Electrophysiology, Vol. 21, No. 10, 10.2010, p. 1071-1078.

Research output: Contribution to journalArticle

Wokhlu, Anita ; Hodge, David O. ; Monahan, Kristi H. ; Asirvatham, Samuel J ; Friedman, Paul Andrew ; Munger, Thomas M. ; Cha, Yong-Mei ; Shen, Win Kuang ; Brady, Peter A. ; Bluhm, Christine M. ; Haroldson, Janis M. ; Hammill, Stephen C. ; Packer, Douglas L. / Long-term outcome of atrial fibrillation ablation : Impact and predictors of very late recurrence. In: Journal of Cardiovascular Electrophysiology. 2010 ; Vol. 21, No. 10. pp. 1071-1078.
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AU - Friedman, Paul Andrew

AU - Munger, Thomas M.

AU - Cha, Yong-Mei

AU - Shen, Win Kuang

AU - Brady, Peter A.

AU - Bluhm, Christine M.

AU - Haroldson, Janis M.

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N2 - 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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