Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success
Abstract
BACKGROUND: In the meantime, catheter ablation is widely used for the treatment of persistent atrial fibrillation (AF). There is a paucity of data about long-term outcomes. This study evaluates (1) 5-year single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after catheter ablation of persistent AF using the stepwise approach aiming at AF termination. METHODS AND RESULTS: A total of 549 patients with persistent AF underwent de novo catheter ablation using the stepwise approach (2007-2009). A total of 493 patients were included (Holter ECGs ≥ every 6 months). Mean follow-up was 59 ± 16 months with 2.1 ± 1.1 procedures per patient. Single and multiple procedure success rates were 20.1% and 55.9%, respectively (80% off antiarrhythmic drug). Antiarrhythmic drug-free multiple procedure success was 46%. Long-term recurrences (n=171) were paroxysmal AF in 48 patients (28%) and persistent AF/atrial tachycardia in 123 patients (72%). Multivariable recurrent event analysis revealed the following factors favoring arrhythmia recurrence: failure to terminate AF during index procedure (hazard ratio [HR], 1.279; 95% confidence interval [CI], 1.093-1.497; P = 0.002), number of procedures (HR, 1.154; 95% CI, 1.051-1.267; P = 0.003), female sex (HR, 1.263; 95% CI, 1.027-1.553; P = 0.027), and the presence of structural heart disease (HR, 1.236; 95% CI, 1.003-1.524; P = 0.047). AF termination was correlated with a higher rate of consecutive procedures because of atrial tachycardia recurrences (P = 0.003; HR, 1.71; 95% CI, 1.20-2.43). CONCLUSIONS: Catheter ablation of persistent AF using the stepwise approach provides limited long-term freedom of arrhythmias often requiring multiple procedures. AF termination, the number of procedures, sex, and the presence of structural heart disease correlate with outcome success. AF termination is associated with consecutive atrial tachycardia procedures.
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There are insufficient data to guide the use of more extensive ablations in patients with persistent atrial fibrillation.
“More extensive ablations have been used in patients with persistent AF, but there are insufficient data to guide the use of these at present.117,718,719,[735][736][737]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [718]
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References 44 · Cited by 175
- Authors
- Schreiber, D., Rostock, T., Fröhlich, M., Sultan, A., Servatius, H., Hoffmann, B. A., Lüker, J., Berner, I., Schäffer, B., Wegscheider, K., Lezius, S., Willems, S., & Steven, D.
- Affiliations
- Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Schreiber, Doreen
- Rostock, Thomas
- ORCID
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2015-04
- Volume
- 8
- Issue
- 2
- Pages
- 308-317
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2059589194
- Cited by
- 175
- References
- 44
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 16 · 2023: 15 · 2022: 12 · 2021: 13 · 2020: 19 · 2019: 13 · 2018: 16 · 2017: 22 · 2016: 27 · 2015: 9
- FWCI
- 17.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (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, stepwise approach, arrhythmia recurrence, long-term outcomes, procedural success, atrial tachycardia, prognostic factors, structural heart disease, sex differences, recurrence risk stratification, recurrence risk score
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Female, Follow-Up Studies, Heart Rate, Humans, Male, Middle Aged, Predictive Value of Tests, Recurrence, Reoperation, Retrospective Studies, Risk Factors, Sex Factors, Tachycardia, Supraventricular, Time Factors, Electrocardiography, Ambulatory, Multivariate Analysis, Treatment Outcome, Catheter Ablation, Disease-Free Survival, Kaplan-Meier Estimate, Young Adult
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