Long-term follow-up after radiofrequency catheter ablation of atrial fibrillation: role of the acute procedure outcome and of the clinical presentation.
OBJECTIVE
This study is a single centre long-term experience on a consecutive cohort of patients with paroxysmal or persistent atrial fibrillation (AF) undergoing electrical disconnection of pulmonary veins (PVs) by means of catheter ablation. Long-term outcome was analyzed in relation to acute procedure success and to the clinical presentation.


RESULTS
Two hundred and thirty-four patients (182 males, mean age 55.9+/-10.6 years), affected by paroxysmal (78%) or persistent AF, underwent an electrophysiologically guided isolation of PVs. ECG, Holter and clinical follow-up were obtained at 1, 3, 6 and 12 months. At discharge an antiarrhythmic drug, Flecainide, was given only in cases with incomplete disconnection; Amiodarone was administered in all persistent AF pts. Successful disconnection of all PVs was achieved in 90% of cases. The rate of stable sinus rhythm maintenance was 85%, 74%, 72% and 65% at 1, 3, 6 and 12 months, respectively. The one-year arrhythmia free survival rates were higher among patients with paroxysmal AF (68% vs. 54%, P 0.008), those with complete disconnection of all PVs and in patients younger than 55 years.


CONCLUSIONS
The electrical disconnection of all the pulmonary veins should be the minimal endpoint of radiofrequency catheter ablation in patients with either paroxysmal or persistent AF. Incomplete disconnection of the PVs is predictive of recurrence. Long-term results of the ablation procedure were significantly better in patients with paroxysmal AF.
Della Bella
Paolo
P
Arrhythmia Department, Centro Cardiologico Monzino, Institute of Cardiology, University of Milan, Via Parea 4, Milan 20138, Italy. pdellabella@ccfm.it
Riva
Stefania
S
Fassini
Gaetano
G
Casella
Michela
M
Carbucicchio
Corrado
C
Trevisi
Nicola
N
Berti
Marco
M
Giraldi
Francesco
F
Maccabelli
Giuseppe
G
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012008:Recurrence; D016896:Treatment Outcome