Incremental Efficacy for Repeat Ablation Procedures for Catheter Ablation of Atrial Fibrillation: 5-Year Follow-Up

Abstract

BackgroundCatheter ablation atrial fibrillation (AF) is effective, but 20% to 40% of patients will require a repeat ablation. The role of more than 1 repeat ablation is not well known. ObjectivesThe purpose of this study was to evaluate the effectiveness and incremental benefits of multiple repeat catheter ablations to treat AF in patients. MethodsWe retrospectively included patients who underwent their first, second, third, and fourth AF ablation between 2004 and 2019. They were monitored with a 24-to-48-hour Holter every 3 months postablation the first year and every 6 to 12 months thereafter. Recurrence was defined as documented atrial arrhythmia >30 seconds. Outcomes are analyzed by Kaplan-Meier curves and compared by log rank test. ResultsWe included a total of 2,194 patients (64% with paroxysmal and 36% with nonparoxysmal AF). Mean age was 71 ± 10 years; 67% were male. After 1 ablation, freedom from AF was 52%. Among those 1,052 patients who had recurrences, 576 (55%) underwent a second ablation, 103 (10%) underwent a third procedure, and 20 (2%) underwent a fourth. Success rates for the second, third, and fourth ablation were 57%, 60%, and 40%, respectively, at 5-year follow-up. After the second ablation, freedom from AF in our entire cohort increased from 52% to 66%, with marginal changes after the third (67%) and fourth (67%) procedures. ConclusionsAlthough repeated ablations demonstrated significant benefits at the individual level, the success rate may drop off after a third. The overall success of the initial cohort was not significantly influenced by the success rates of multiple follow-up ablations.