Clinical Research
Heart Rhythm Disorders
Catheter Ablation of Long-Standing Persistent Atrial Fibrillation: 5-Year Outcomes of the Hamburg Sequential Ablation Strategy

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Objectives

This study describes the 5-year efficacy of catheter ablation for long-standing persistent atrial fibrillation (LS-AF).

Background

Long-term outcome data after catheter ablation for LS-AF are limited.

Methods

Long-term follow-up of 56 months (range 49 to 67 months) was performed in 202 patients (age 61 ± 9 years) who underwent the sequential ablation strategy for symptomatic LS-AF. Initial ablation strategy was circumferential pulmonary vein isolation (PVI). Additional ablation was performed only in acute PVI nonresponder, if direct current cardioversion failed after PVI.

Results

After the first ablation procedure, sinus rhythm was documented in 41 of 202 (20.3%) patients. After multiple procedures, sinus rhythm was maintained in 91 of 202 (45.0%) patients, including 24 patients receiving antiarrhythmic drugs. In 105 patients, PVI was the sole ablative therapy, 49 (46.7%) of those patients remained in sinus rhythm during follow-up. Patients with a total AF duration of <2 years had a significantly higher ablation success rate than patients whose AF duration was >2 years (76.5% vs. 42.2%, respectively; p = 0.033). Persistent AF duration (hazard ratio: 1.09 [95% confidence interval: 1.04 to 1.13]; p < 0.001) independently predicted arrhythmia recurrences, and acute PVI responders had a reduced risk of relapse (hazard ratio: 0.57 [95% confidence interval: 0.41 to 0.78]; p < 0.001) after the first ablation.

Conclusions

During 5-year follow-up, single- and multiple ablation procedure success was 20% and 45%, respectively, for patients with LS-AF. For patients with a total AF duration of <2 years, the outcomes were favorable.

Key Words

catheter ablation
long-standing persistent atrial fibrillation
long-term outcome

Abbreviations and Acronyms

AAD
antiarrhythmic drug
AF
atrial fibrillation
AT
atrial tachycardia
CFAE
complex fractionated atrial electrograms
CI
confidence interval
HR
hazard ratio
LA
left atrium
LS-AF
long-standing persistent atrial fibrillation
OAC
oral anticoagulation
PAF
paroxysmal atrial fibrillation
PV
pulmonary vein
PVI
pulmonary vein isolation
SR
sinus rhythm

Cited by (0)

Dr. Tilz has received travel grants, research grants, and speakers’ honoraria from Biosense Webster and St. Jude Medical. Dr. Rillig has received travel grants from St. Jude Medical and Biosense Webster. Prof. Kuck has received research grants from Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, and Cryocath; and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.