title: Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up?
abstract: OBJECTIVE
  This study describes 5-year follow-up results of catheter ablation for atrial fibrillation (AF).
  
  
  BACKGROUND
  Long-term efficacy following catheter ablation of AF remains unknown.
  
  
  METHODS
  A total of 100 patients (86 men, 14 women), age 55.7 ± 9.6 years, referred to our center for a first AF ablation (63% paroxysmal; 3.5 ± 1.4 prior ineffective antiarrhythmic agents) were followed for 5 years. Complete success was defined as absence of any AF or atrial tachycardia recurrence (clinical or by 24-h Holter monitoring) lasting ≥ 30 s.
  
  
  RESULTS
  Arrhythmia-free survival rates after a single catheter ablation procedure were 40%, 37%, and 29% at 1, 2, and 5 years, respectively, with most recurrences over the first 6 months. Patients with long-standing persistent AF experienced a higher recurrence rate than those with paroxysmal or persistent forms (hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.0 to 3.5; p = 0.0462). In all, 175 procedures were performed, with a median of 2 per patient. Arrhythmia-free survival following the last catheter ablation procedure was 87%, 81%, and 63% at 1, 2, and 5 years, respectively. Valvular heart disease (HR: 6.0, 95% CI: 2.0 to 17.6; p = 0.0012) and nonischemic dilated cardiomyopathy (HR: 34.0, 95% CI: 6.3 to 182.1; p < 0.0001) independently predicted recurrences. Major complications (cardiac tamponade requiring drainage) occurred in 3 patients (3%).
  
  
  CONCLUSIONS
  In selected patients with AF, a catheter ablation strategy with repeat intervention as necessary provides acceptable long-term relief. Although most recurrences transpire over the first 6 to 12 months, a slow but steady decline in arrhythmia-free survival is noted thereafter.
authors.affiliation: Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France. rukshen@afablationclinic.com.au
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Jean
authors.initials: J
authors.lastname: Litalien
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
authors.forename: Sebastien
authors.initials: S
authors.lastname: Knecht
authors.forename: Matthew
authors.initials: M
authors.lastname: Wright
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavee
authors.forename: Jacques
authors.initials: J
authors.lastname: Clementy
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome