Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint
Abstract
AIMS: Catheter ablation of long-lasting persistent atrial fibrillation (AF) has been performed with varying results using a combination of different techniques. Whether arrhythmia termination during ablation is associated with an improved clinical outcome is controversial. METHODS AND RESULTS: In this prospective study, 153 consecutive patients (56 +/- 10 years) underwent catheter ablation of persistent AF (25 +/- 33 months) using a stepwise approach with the desired procedural endpoint being AF termination. Repeat ablation was performed for patients with recurrent AF or atrial tachycardia (AT) after a 1 month blanking period. A minimum follow-up of 12 months with repeated Holter monitoring was performed. Atrial fibrillation was terminated in 130 patients (85%). There was a lower incidence of AF in those patients in whom AF was terminated during the index procedure compared with those who had not (5 vs. 39% P < 0.0001, mean follow-up 32 +/- 11 months). Seventy-nine patients underwent repeat procedures: 64/130 in the termination group (6 AF, 58 AT) and 15 in the non-termination group (9 AF, 7 AT). After repeat ablation, sinus rhythm was maintained in 95% in whom AF was terminated compared with 52% in those in whom AF could not be terminated. CONCLUSION: Procedural termination of long-lasting AF by catheter ablation alone is associated with an improved outcome.
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Extensive left atrial ablation beyond pulmonary vein isolation carries a potentially increased risk of macroreentrant or focal iatrogenic atrial tachycardias, and its value is not well established in patients with paroxysmal or persistent atrial fibrillation.
“However, these techniques carry a potentially increased risk of macroreentrant or focal iatrogenic atrial tachycardias, 197,207 and their value is rather not established in patients with paroxysmal or persistent AF. 208 -210”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [207]
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- Authors
- O'Neill, M. D., Wright, M., Knecht, S., Jais, P., Hocini, M., Takahashi, Y., Jonsson, A., Sacher, F., Matsuo, S., Lim, K. T., Arantes, L., Derval, N., Lellouche, N., Nault, I., Bordachar, P., Clementy, J., & Haissaguerre, M.
- Affiliations
- Hôpital Cardiologique du Haut-Lévêque (FR)
- Corresponding author
- Wright, M.
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-03-08
- Volume
- 30
- Issue
- 9
- Pages
- 1105-1112
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2130677268
- Cited by
- 333
- References
- 36
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 14 · 2023: 10 · 2022: 8 · 2021: 8 · 2020: 6 · 2019: 13 · 2018: 13 · 2017: 24 · 2016: 23 · 2015: 28 · 2014: 20 · 2013: 34 · 2012: 54
- FWCI
- 25.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- persistent atrial fibrillation, catheter ablation, procedural endpoint, arrhythmia termination, repeat ablation, atrial tachycardia, long-term outcomes, sinus rhythm maintenance
- MeSH terms
- Aged, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Reoperation, Treatment Outcome, Catheter Ablation
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