Long term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients
Open accessAbstract
AIMS: Identifying suitable candidates for circumferential left atrial pulmonary vein ablation (CPVA). CPVA is widely used as an ablation strategy in patients with atrial fibrillation (AF). Understanding the predictors of long-term success of single catheter ablation procedure of AF based on CPVA can help to identify those patients who have a high risk of recurrence based on this approach. METHODS AND RESULTS: In this retrospective analysis 674 consecutive patients (464 male, mean age 57.3 +/- 10.8 years) with AF (84.8%, paroxysmal) treated with CPVA ablation between May 2005 and August 2007 using a manually controlled steerable sheath (Agilis((R)) St. Jude Medical Inc., St. Paul, MN, USA), were included. The endpoint of the ablation was the completion of predefined lesions (CPVA for paroxysmal, and CPVA+mitral isthmus and roof line ablation for persistent AF). Seven day Holter recordings were done immediately, 3, 6, and 12 month after ablation. AF longer than 30 s was considered as recurrence. The success was defined as lack of recurrence during 7-day Holter recordings done 3, 6, and 12 months after ablation. Early recurrence was defined as recurrence during the first 7-day Holter recording immediately after ablation. Forty-five and 20.8% of the patients received antiarrhythmic medications for the first 3 and 6 months after ablation procedure, respectively. After 6 months all antiarrhythmics were discontinued. About 51.5% experienced early recurrence. Twelve months success rate was 75.7% (paroxysmal: 75.7%, persistent: 75.0%, P = 1.0). Using multivariate analysis left atrial (LA) diameter > or =50 mm was the predictor of early recurrence {Hazard Ratio (HR) [95% confidence interval (CI)] = 5.1 (2.0-12.9)}. LA Diameter > or =50 mm [HR (95% CI) = 4.6 (2.6-9.1)]; early recurrence [HR (95% CI) = 4.3 (2.0-9.1)]; and arterial hypertension [HR (95% CI) = 4.6 (2.6-9.1)] were predictors of late recurrence. CONCLUSION: In our patients' cohort, a single catheter ablation procedure based on CPVA using steerable sheath for catheter navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.
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Very early AF events in the first 2 weeks may predict long-term failure, and AF during the blanking period may indicate greater likelihood of need for additional procedures or drugs.
“Very early AF events in the first 2 weeks may predict long-term failure (Joshi et al., 2009), and AF during the blanking period may indicate greater likelihood of need for additional procedures or drugs (Arya et al., 2010).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Arya et al., 2010
Arya et al. define early recurrence during the first 7 days after ablation and report that it predicts long-term failure (Major findings, p. 5). Their Follow-up section (p. 3) says antiarrhythmic drugs were added after early in-hospital AF recurrence. The paper does not establish that AF throughout the blanking period predicts a greater likelihood of needing additional procedures or drugs; its measured early-recurrence window was narrower, and it does not report that association for repeat procedures. (LLM, conf=0.82)
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- Authors
- Arya, A., Hindricks, G., Sommer, P., Huo, Y., Bollmann, A., Gaspar, T., Bode, K., Husser, D., Kottkamp, H., & Piorkowski, C.
- Affiliations
- Leipzig University (DE)
- Leipzig Heart Institute (DE)
- Klinik Hirslanden (CH)
- Corresponding author
- Arya, A.
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11-03
- Volume
- 12
- Issue
- 2
- Pages
- 173-180
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2122430122
- Cited by
- 158
- References
- 29
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 9 · 2021: 7 · 2020: 12 · 2019: 11 · 2018: 9 · 2017: 10 · 2016: 12 · 2015: 14 · 2014: 11 · 2013: 13 · 2012: 22
- FWCI
- 8.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- 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
- atrial fibrillation, catheter ablation, circumferential pulmonary vein ablation, left atrial diameter, atrial fibrillation recurrence, prognostic factors, paroxysmal atrial fibrillation, persistent atrial fibrillation, mitral isthmus ablation, hypertension, antiarrhythmic drugs, long-term follow-up, Holter monitoring
- MeSH terms
- Aged, Atrial Fibrillation, Electrocardiography, Female, Follow-Up Studies, Heart Atria, Cardiac Catheterization, Humans, Longitudinal Studies, Male, Middle Aged, Predictive Value of Tests, Pulmonary Veins, Recurrence, Retrospective Studies, Time Factors, Electrocardiography, Ambulatory, Prevalence, Multivariate Analysis, Treatment Outcome, Catheter Ablation
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