title: Long-term outcome of atrial fibrillation ablation: impact and predictors of very late recurrence.
abstract: BACKGROUND
  Ablation eliminates atrial fibrillation (AF) in studies with 1 year follow-up, but very late recurrences may compromise long-term efficacy. In a large cohort, we sought to describe the determinants of delayed recurrence after AF ablation.
  
  
  RESULTS
  Seven hundred and seventy-four patients with AF (428 paroxysmal [PAF, 55%] and 346 persistent or longstanding persistent [PersAF, 45%]) underwent wide area circumferential ablation (WACA, 62%) or pulmonary vein isolation (38%). Over 3.0 ± 1.9 years, there were 135 recurrences in PAF patients and 142 in PersAF patients. AF elimination was achieved in 61% of patients with PersAF at 2 years after last ablation and in 71% of patients with PAF (P = 0.04). This finding was related to a higher initial rate of very late recurrence in PersAF. From 1.0 to 2.5 years, the recurrence increased by 20% (from 37% to 57%) in PersAF patients versus only 12% (from 27% to 39%) in PAF patients. Independent predictors of overall recurrence included diabetes (HR 1.9 [1.3-2.9], P = 0.002) and PersAF (HR 1.6 [1.2-2.0], P < 0.001). Independent predictors of very late recurrence included PersAF (HR 1.7 [1.1-2.7], P = 0.018) and WACA (HR 1.8 [1.1-2.7], P = 0.018), while diabetes came close to significance. In PAF patients, left atrial size >45 mm was identified as an AF-type specific predictor (HR 2.4 [1.3-4.7], P = 0.009), whereas in PersAF patients, no unique predictors were identified.
  
  
  CONCLUSIONS
  Late recurrences reduced the long-term efficacy of AF ablation, particularly in patients with PersAF and underlying cardiovascular diseases.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Wokhlu
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Kristi H
authors.initials: KH
authors.lastname: Monahan
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Munger
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
authors.forename: Win-Kuang
authors.initials: WK
authors.lastname: Shen
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brady
authors.forename: Christine M
authors.initials: CM
authors.lastname: Bluhm
authors.forename: Janis M
authors.initials: JM
authors.lastname: Haroldson
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome