Europace Advance Access published online on November 3, 2009
Europace, doi:10.1093/europace/eup349
CLINICAL RESEARCH
Does catheter ablation cure atrial fibrillation? Single-procedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicentre experience
1 Ospedale Civile di Mirano, Via Ca'Rossa, 35, 30173 Venezia, Italy; 2 Ospedale San Camillo, Rome, Italy; 3 Clinica San Michele, Maddaloni (CE), Italy; 4 Istituto Clinico Sant'Ambrogio, Milano, Italy; 5 Clinica Mediterranea, Napoli, Italy
Aims: In the last decade, several approaches to ablating triggers and substrates of atrial fibrillation (AF) have been developed. However, most studies have reported data only on short- or medium-term follow-up. The aim of this study was to investigate whether the 1-year efficacy of catheter ablation for AF is predictive of long-term clinical success.
Methods and results: Between February 2001 and October 2003, 229 consecutive patients affected by drug-refractory paroxysmal or persistent AF underwent a single radiofrequency catheter ablation procedure (anatomical approach in 146 patients and electrophysiologically guided approach in 83 patients). Of these patients, 177 (mean age 59.1 ± 10.5 years, 57.6% with paroxysmal AF) were free from any atrial arrhythmia recurrence after 12 months. These 177 patients were subsequently followed up for at least another 24 months, by means of electrocardiogram and 24 h Holter monitoring. After a mean follow-up of 49.7 ± 13.3 months (range 36–83 months), 58.2% of the patients were free from any atrial arrhythmia recurrence (39.5% without antiarrhythmic drugs). The actuarial atrial arrhythmia recurrence rate was 13.0% at 2 years, 21.8% at 3 years, 35.0% at 4 years, 46.8% at 5 years, and 54.6% at 6 years. Atrial arrhythmia-free survival was similar in patients with paroxysmal or persistent AF, with and without antiarrhythmic drugs during the follow-up, who underwent electrophysiologically guided pulmonary vein (PV) isolation or anatomical PV ablation.
Conclusion: Even patients in whom catheter ablation prevents AF recurrence for 1 year should not be considered ‘cured’, since >40% of them will suffer AF recurrence over a long-term clinical follow-up.
Key Words: Atrial fibrillation, Catheter ablation, Long-term results
* Corresponding author. Tel: +39 0415794253, Fax: +39 0415794309, Email: bertagliaferro{at}alice.it
Manuscript submitted 9 March 2009. Accepted after revision 13 October 2009.