Long-term outcomes after radiofrequency catheter ablation of paroxysmal and persistent atrial fibrillation

Abstract

Background : Short-term oucomes of radiofrequency (RF) catheter isolation of the pulmonary veins (PVs) in patients with paroxysmal or persistent atrial fibrillation (PAF/PEAF) are encouraging. However, long-term outcomes are not well defined. Therefore, we evaluated 3–5-year outcomes in our series of patients. Freedom from symptomatic AF/flutter/tachycardia recurrences with patients off antiarrhythmic drugs (AAD) was considered a treatment success. Methods : Consecutive patients with symptomatic PAF/PEAF and AAD failure, without significant structural heart disease, were prospectively recruited between September 2003 and November 2009. Irrigated-tip RF ablation catheter and Lasso catheter were used after standard trans-septal approach with X-ray fluoroscopic guidance. Ablation endpoints were: complete segmental/circumferential ostial and antral electrical PV isolation, non-PV foci ablation, and bi-directional flutter isthmus (FI) block when indicated. The procedure was repeated if AF/flutter/tachycardia recurred after 3-month blanking period. The suspected arrhythmia recurrences were evaluated by series of ECG/Holter recordings. Data were analyzed by t-, chi-square, and Fisher’s exact tests. P < 0.05 was considered statistically significant. Results : In 126 patients, median age 55 years (range 19–75), 94 men (75 %), 86 with PAF and 40 with PEAF (31 %), 207 procedures were performed: single in 63 (50 %), double in 48 (38 %), and multiple in 15. FI was ablated in 53 patients (42 %). Tamponade occurred in 4 (3 %). No PV stenosis, esophageal injury, or stroke were detected clinically in 115 patients (91 %) during 36-month (13–89) follow-up. We achieved treatment success in 69 patients (61 %), partial success with a significant reduction of AF/flutter/tachycardia recurrences on AAD in 13 patients (12 %), and in 33 patients (27 %) the procedure was not successful. Overall, 73 % of our patients had long-term benefit. Outcomes were better in patients with PAF vs. PEAF (84 % vs. 48 %, p < 0,001), in younger age, in those without concomitant diseases, and in those with normal PV anatomy. These results were maintained in the subgroup of 58 patients over 56 months of follow-up: 35 (60 %), 6 (11 %), and 17 (29 %), respectively. Conclusions : Lasso-guided RF irrigated-tip segmental/circumferential PV isolation is a safe and long-term successful treatment of PAF in the majority of our patients. The method needs improvements in patients with PEAF, possibly with the introduction of new technologies.