Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy.
OBJECTIVE
This study describes the 5-year efficacy of catheter ablation for long-standing persistent atrial fibrillation (LS-AF).


BACKGROUND
Long-term outcome data after catheter ablation for LS-AF are limited.


METHODS
Long-term follow-up of 56 months (range 49 to 67 months) was performed in 202 patients (age 61 ± 9 years) who underwent the sequential ablation strategy for symptomatic LS-AF. Initial ablation strategy was circumferential pulmonary vein isolation (PVI). Additional ablation was performed only in acute PVI nonresponder, if direct current cardioversion failed after PVI.


RESULTS
After the first ablation procedure, sinus rhythm was documented in 41 of 202 (20.3%) patients. After multiple procedures, sinus rhythm was maintained in 91 of 202 (45.0%) patients, including 24 patients receiving antiarrhythmic drugs. In 105 patients, PVI was the sole ablative therapy, 49 (46.7%) of those patients remained in sinus rhythm during follow-up. Patients with a total AF duration of <2 years had a significantly higher ablation success rate than patients whose AF duration was >2 years (76.5% vs. 42.2%, respectively; p = 0.033). Persistent AF duration (hazard ratio: 1.09 [95% confidence interval: 1.04 to 1.13]; p < 0.001) independently predicted arrhythmia recurrences, and acute PVI responders had a reduced risk of relapse (hazard ratio: 0.57 [95% confidence interval: 0.41 to 0.78]; p < 0.001) after the first ablation.


CONCLUSIONS
During 5-year follow-up, single- and multiple ablation procedure success was 20% and 45%, respectively, for patients with LS-AF. For patients with a total AF duration of <2 years, the outcomes were favorable.
Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, Hamburg, Germany. tilz6@hotmail.com
Roland Richard
RR
Tilz
Andreas
A
Rillig
Anna-Maria
AM
Thum
Anita
A
Arya
Peter
P
Wohlmuth
Andreas
A
Metzner
Shibu
S
Mathew
Yasuhiro
Y
Yoshiga
Erik
E
Wissner
Karl-Heinz
KH
Kuck
Feifan
F
Ouyang
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000639:trends; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome