Long-term Follow-up Outcomes After Atrial Fibrillation Radiofrequency Catheter Ablation

Part1:Predictors of Long-term Outcomes after Paroxysmal Atrial Fibrillation Radiofrequency Catheter AblationObjective:This study aimed to reveal long-term efficacy of radiofrequency catheter ablation(RFCA)for paroxysmal atrial fibrillation(PAF)and identify predictors of late recurrence of atrial fibrillation(LRAF)after a single procedure.Methods:A total of 243 patients with PAF,148 male and 97 female,aged 58.46±11.20 years,accepted circumferential pulmonary vein isolation(CPVI)alone or CPVI combined additional ablation.Results:Maintenance rate of sinus rhythm(SR)was 60.5%after a single procedure with median follow-up of 37 months and 74.9%after a mean 1.3 ± 0.6 procedure with median follow-up of 42 months.Left atrial diameter(LAD)(OR=1.100,95%CI1.032-1.172,P=0.003),left inferior pulmonary vein superior-inferior diameter(LIPVSID)(OR=1.095,95%CI 1.014-1.183,P=0.020),CPVI combined additional ablation(OR=2.291,95%CI1.141-4.600,P=0.020)and early recurrence of atrial fibrillation(ERAF)(OR=6.910,95%CI 3.728-12.807,P<0.001)were predictors of LRAF after a single procedure.The best cutoff value for LAD was 35.5mm,furthermore,patients with LAD<35.5mm had better outcome.Conclusion:RFCA leaded to maintain SR in 60.5%and 74.9%patients with PAF after single-and multiple-procedure,respectively,with over 3 years follow-up.LAD,LIPVSID,CPVI combined additional ablation and ERAF were predictors of LRAF after a single procedure.RFCA is more suitable for patients without enlargement of LA and additional ablation should be carefully considered for PAF.PART2:Long-term outcome of radiofrequency catheter ablation for persistent atrial fibrillationObjective:This study aimed to investigate long-term efficacy of radiofrequency catheter ablation(RFCA)for PerAF and explore predictors of late recurrence of atrial fibrillation(LRAF).Methods:92 consecutive patients with PerAF(64 males,aged 56.42±11.24 years)were enrolled in this study and accepted circumferential pulmonary vein isolation(CPVI)alone or CPVI combined additional ablation.Results:Maintenance rate of sinus rhythm(SR)was 40.2%after a single procedure with median follow-up of 15 months and 52.2%after mean 1.3 ± 0.6 procedures with median follow-up of 26 months.Long-term SR maintenance rate was no statistical difference between patients with CPVI alone and with CPVI combined additional ablation(48.6%vs.35.1%,log rank test,P=0.152).AF duration(OR=1.015,95%CI 1.001-1.030,P=0.015)and early recurrence of AF(ERAF)(OR=10.654,95%CI 3.853-29.460,P<0.001)were predictors of LRAF after a single procedure.Patients with AF duration<24months had a higher long-term SR maintenance rate than those with AF duration ? 24 months(55.6%vs.30.4%,log rank test,P=0.022).Conclusions:Long-term maintenance SR rate was 52.2%in patients with PerAF after multiple procedures with a median over 2-year follow-up.AF duration and ERAF were predictors of LRAF after a single procedure.Patients with AF duration<24 months had better outcome.Therefore,PerAF should be performed at early stage in the course of the AF journey.