title: Long-term single- and multiple-procedure outcome and predictors of success after catheter ablation for persistent atrial fibrillation.
abstract: BACKGROUND
  Stepwise ablation is an effective treatment for persistent atrial fibrillation (AF), although it often requires multiple procedures to eliminate recurrent arrhythmias.
  
  
  OBJECTIVE
  This study evaluated single- and multiple-procedure long-term success rates and potential predictors of a favorable single-procedure outcome of stepwise ablation for persistent AF.
  
  
  METHODS
  This study comprised 395 patients with persistent AF (duration 16 months) undergoing de novo catheter ablation using the stepwise approach. Procedural success was defined as the absence of any arrhythmia recurrence. Patient characteristics and electrophysiological parameters were analyzed with respect to single- and multiple-procedure outcomes.
  
  
  RESULTS
  After a follow-up of 27 ± 7 months, 108 (27%) patients were free of arrhythmia recurrences with a single procedure. After 2.3 ± 0.6 procedures, 312 (79%) patients were free of arrhythmia with concomitant antiarrhythmic treatment in 38% (23% on β-blocker). Female gender, duration of persistent AF, and congestive heart failure were predictive for the outcome after first ablation. However, the strongest predictors for single-procedure success were longer baseline AF cycle length (CL) and procedural AF termination. Moreover, procedural AF termination during the index procedure also predicted a favorable outcome after the last procedure, while the existence of congestive heart failure was associated with an increased risk for eventual arrhythmia recurrences.
  
  
  CONCLUSIONS
  Single-procedure long-term success is anticipated in approximately a quarter of patients undergoing de novo ablation of persistent AF. Baseline AFCL emerged as the strongest predictor of single-procedure success, while AF termination during index ablation predicts the overall outcome. However, an overall success rate of 79% is achievable with multiple procedures.
authors.affiliation: Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany. throstock@gmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Tushar V
authors.initials: TV
authors.lastname: Salukhe
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Imke
authors.initials: I
authors.lastname: Drewitz
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.forename: Karsten
authors.initials: K
authors.lastname: Bock
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.forename: Kai
authors.initials: K
authors.lastname: Müllerleile
authors.forename: Arian
authors.initials: A
authors.lastname: Sultan
authors.forename: Nils
authors.initials: N
authors.lastname: Gosau
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003663:Decision Trees; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome