Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint
Open accessAbstract
BACKGROUND: This study aimed to determine 5-year efficacy of catheter ablation for persistent atrial fibrillation (AF) using AF termination as a procedural end point. METHODS AND RESULTS: One hundred fifty patients (57±10 years) underwent persistent AF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided, and linear ablation) with the desired procedural end point being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia. AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3%±3.9%, 28.0%±3.7%, and 16.8%±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7%±2.5%, 79.8%±3.4%, and 62.9%±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (interquartile range, 43-73) months after the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs. Another 14 (9.3%) patients maintained sinus rhythm after reinitiation of antiarrhythmic drugs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (hazard ratio 3.831; 95% confidence interval, 2.070-7.143; P<0.001), left atrial diameter≥50 mm (hazard ratio 2.083; 95% confidence interval, 1.078-4.016; P=0.03), continuous AF duration≥18 months (hazard ratio 1.984; 95% confidence interval, 1.024-3.846; P<0.04), and structural heart disease (hazard ratio 1.874; 95% confidence interval, 1.037-3.388; P=0.04) predicted arrhythmia recurrence. CONCLUSIONS: In patients with persistent AF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow-up period. Procedural AF nontermination and specific baseline factors predict long-term outcome after ablation.
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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 [719]
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Research works printed but not linked: 7
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- Dallas, TX 75231 is published by the American Heart Association, 7272 Greenville Avenue, Circulation: Arrhythmia and Electrophysiology published online December 20, 2014; Circ Arrhythm Electrophysiol. http://circep.ahajournals.org/content/early/2014/12/20/CIRCEP.114.001943 World Wide Web at: The online version of this article, along with updated information and services, is located on the http://circep.ahajournals.org/content/suppl/2014/12/20/CIRCEP.114.001943.DC1.html Data Supplement (unedited) at: http://circep.ahajournals.org//subscriptions/ is online at: Circulation: Arrhythmia and Electrophysiology Information about subscribing to Subscriptions: http://www.lww.com/reprints Information about reprints can be found online at: Reprints: document. Permissions and Rights Question and Answer information about this process is available in the requested is located, click Request Permissions in the middle column of the Web page under Services. Further
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
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Self-citation
- Authors
- Scherr, D., Khairy, P., Miyazaki, S., Aurillac-Lavignolle, V., Pascale, P., Wilton, S. B., Ramoul, K., Komatsu, Y., Roten, L., Jadidi, A., Linton, N., Pedersen, M., Daly, M., O’Neill, M., Knecht, S., Weerasooriya, R., Rostock, T., Manninger, M., Cochet, H., Shah, A. J., Yeim, S., Denis, A., Derval, N., Hocini, M., Sacher, F., Haissaguerre, M., & Jais, P.
- Affiliations
- Hôpital Cardiologique du Haut-Lévêque (FR)
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
- ORCID
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2015-02
- Volume
- 8
- Issue
- 1
- Pages
- 18-24
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2106377001
- Cited by
- 303
- References
- 30
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 25 · 2023: 23 · 2022: 20 · 2021: 20 · 2020: 33 · 2019: 31 · 2018: 33 · 2017: 43 · 2016: 34 · 2015: 20
- FWCI
- 22.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Open Access CRIS of the University of Bern
- 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, pulmonary vein isolation, linear ablation, arrhythmia-free survival, repeat ablation, left atrial diameter, structural heart disease, atrial tachycardia, long-term outcomes, procedural endpoint, antiarrhythmic drugs, sinus rhythm
- MeSH terms
- Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Pulmonary Veins, Recurrence, Reoperation, Risk Factors, Tachycardia, Supraventricular, Time Factors, Proportional Hazards Models, Treatment Outcome, Catheter Ablation, Disease-Free Survival, Electrophysiologic Techniques, Cardiac, Kaplan-Meier Estimate
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