Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint.
OBJECTIVE
Catheter ablation of long-lasting persistent atrial fibrillation (AF) has been performed with varying results using a combination of different techniques. Whether arrhythmia termination during ablation is associated with an improved clinical outcome is controversial.


RESULTS
In this prospective study, 153 consecutive patients (56 +/- 10 years) underwent catheter ablation of persistent AF (25 +/- 33 months) using a stepwise approach with the desired procedural endpoint being AF termination. Repeat ablation was performed for patients with recurrent AF or atrial tachycardia (AT) after a 1 month blanking period. A minimum follow-up of 12 months with repeated Holter monitoring was performed. Atrial fibrillation was terminated in 130 patients (85%). There was a lower incidence of AF in those patients in whom AF was terminated during the index procedure compared with those who had not (5 vs. 39% P < 0.0001, mean follow-up 32 +/- 11 months). Seventy-nine patients underwent repeat procedures: 64/130 in the termination group (6 AF, 58 AT) and 15 in the non-termination group (9 AF, 7 AT). After repeat ablation, sinus rhythm was maintained in 95% in whom AF was terminated compared with 52% in those in whom AF could not be terminated.


CONCLUSIONS
Procedural termination of long-lasting AF by catheter ablation alone is associated with an improved outcome.
O'Neill
Mark D
MD
Service de Rythmologie, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Bordeaux, Pessac, France.
Wright
Matthew
M
Knecht
Sébastien
S
Jaïs
Pierre
P
Hocini
Mélèze
M
Takahashi
Yoshihide
Y
Jönsson
Anders
A
Sacher
Frédéric
F
Matsuo
Seiichiro
S
Lim
Kang Teng
KT
Arantes
Leonardo
L
Derval
Nicolas
N
Lellouche
Nicholas
N
Nault
Isabelle
I
Bordachar
Pierre
P
Clémenty
Jacques
J
Haïssaguerre
Michel
M
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome