title: Natural history and long-term outcomes of ablated atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation is increasingly used in clinical practice. We aimed to study the natural history and long-term outcomes of ablated AF.
  
  
  RESULTS
  We followed 831 patients after pulmonary vein isolation (PVI) performed in 2005. We documented clinical outcomes using our prospective AF registry with most recent update on this group of patients in October 2009. In the first year after ablation, 23.8% had early recurrence. Over long-term follow-up (55 months), only 8.9% had late arrhythmia recurrence defined as occurring beyond the first year after ablation. Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6%. At last follow-up, clinical improvement was 89.9% (79.4% arrhythmia-free off antiarrhythmic drugs and 10.5% with AF controlled with antiarrhythmic drugs). Only 4.6% continued to have drug-resistant AF. It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation (CHADS score ≤2, stroke incidence of 0.06% per year). The procedure-related complication rate was very low.
  
  
  CONCLUSIONS
  Pulmonary vein isolation is safe and efficacious for long-term maintenance of sinus rhythm and control of symptoms in patients with drug-resistant AF. It obviates the need for antiarrhythmic drugs, negative dromotropic agents, and anticoagulants in a substantial proportion of patients.
authors.affiliation: Center for Atrial Fibrillation, the Cleveland Clinic, OH, USA.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Hussein
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: Minerva
authors.initials: M
authors.lastname: Sherman
authors.forename: Christina
authors.initials: C
authors.lastname: Magnelli-Reyes
authors.forename: Mohammed
authors.initials: M
authors.lastname: Chamsi-Pasha
authors.forename: Seby
authors.initials: S
authors.lastname: John
authors.forename: Michelle
authors.initials: M
authors.lastname: Williams-Adrews
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.forename: Thomas
authors.initials: T
authors.lastname: Dresing
authors.forename: Thomas
authors.initials: T
authors.lastname: Callahan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kanj
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Lindsay
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome