Published in:
01-06-2018 | MULTIMEDIA REPORT
Very long-term outcomes after a single catheter ablation procedure for the treatment of atrial fibrillation—the protective role of antiarrhythmic drug therapy
Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2018
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Background
Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but its long-term clinical outcomes, predictors of relapse, and optimal pharmacological treatment remain controversial.
Objective
The objectives of this paper were to (1) assess very long-term AF recurrence, (2) identify predictors of relapse, and (3) evaluate the impact of continued antiarrhythmic drug (AAD) treatment after ablation.
Methods
Multicenter observational registry including all consecutive patients with drug-resistant AF who underwent a first PVI between 2006 and 2008 (n = 253 (age 55 years (IQR 48–63)), 80% males, 64% with paroxysmal AF. Endpoint was AF/AT/AFL relapse after a 3-month blanking period. Predictors and protective factors of AF relapse were assessed with multivariate Cox regression.
Results
A total of 144 patients (57%) relapsed over a median 5-year (IQR 2–9) follow-up—annual relapse rate of 10%/year. Female sex (aHR 1.526, 95% CI 1.037–2.246, P = 0.032), non-paroxysmal AF (aHR 1.410, 95% CI 1.000–1.987, P = 0.050), and LA volume/BSA (aHR 1.012, 95% CI 1.003–1.021, P = 0.008) were identified as independent predictors of relapse. A total of 139 patients (55%) continued AAD (55% on amiodarone) after blanking period. One-year overall PVI success rate of patients under AAD was 86 vs 76% with no AAD (P < 0.001)—annual relapse rates were 8%/year vs 14%/year (P < 0.001), respectively. AAD was associated with a long-term reduction in AF relapse (aHR 0.673, 95% CI 0.509–0.904 P = 0.004).
Conclusion
Half the patients remained free from AF 5 years after a single procedure. Female sex, non-paroxysmal AF, and LA volume/BSA independently predicted recurrence, whereas continuing AAD after the 3-month blanking period reduced relapse.
Condensed abstract
In a multicenter registry of AF patients undergoing a first PVI, 57% relapsed over a median 5-year follow-up. Female sex, non-paroxysmal AF and LA volume/BSA were identified as independent predictors of relapse. Maintaining AAD therapy after the blanking period was associated with a long-term reduction in AF relapse.