Repeat ablation procedures provide “acceptable” long-term relief for AF patients


Five-year follow-up results from a study of catheter ablation for atrial fibrillation showed that arrhythmia-free survival rates after a single ablation procedure are relatively low at 29%. The study conducted by Rukshen Weerasooriya and colleagues at the Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France, also showed that the long-term success increases to 63% when outcomes are measured after the last ablation procedure.

According to the study results, atrial fibrillation recurrences occur over the first six to 12 months, a slow but steady decline in arrhythmia-free survival is noted thereafter. The study “Catheter ablation for atrial fibrillation: Are results maintained at five years of follow-up?” appears in the 11 January 2011 issue of the Journal of the American College of Cardiology.

A total of 100 patients (86 men, 14 women), age 55.7 ± 9.6 years, referred to the Hôpital Cardiologique du Haut-Lévêque for a first atrial fibrillation ablation (63% paroxysmal; 3.5 ± 1.4 prior ineffective anti-arrhythmic agents) were followed for five years. Complete success was defined as absence of any atrial fibrillation or atrial tachycardia recurrence (clinical or by 24h Holter monitoring) lasting > 30s.

Arrhythmia-free survival rates after a single catheter ablation procedure were 40%, 37%, and 29% at one, two, and five years, respectively, with most recurrences over the first six months. Patients with long-standing persistent atrial fibrillation experienced a higher recurrence rate than those with paroxysmal or persistent forms. In all, 175 procedures were performed, with a median of two per patient.

Arrhythmia-free survival following the last catheter ablation procedure was 87%, 81%, and 63% at one, two, and five years, respectively. Valvular heart disease and nonischemic dilated cardiomyopathy independently predicted recurrences. Major complications (cardiac tamponade requiring drainage) occurred in three patients (3%).

In conclusion, the authors wrote, “In selected patients with atrial fibrillation, a catheter ablation strategy with repeat intervention as necessary provides acceptable long-term relief. Although most recurrences transpire over the first six to 12 months, a slow but steady decline in arrhythmia-free survival is noted thereafter.”