Catheter ablation for long-standing persistent atrial fibrillation in patients who have failed electrical cardioversion.
Ablation outcomes in 22 consecutive long-standing persistent atrial fibrillation (LPAF) patients with failed direct current cardioversion (DCCV; group 1) were compared with findings in 22 consecutive LPAF patients who had successful DCCV (control 1) and 22 consecutive patients with paroxysmal atrial fibrillation (AF; control 2). All patients underwent a stepwise progressive ablation protocol (pulmonary vein isolation, ablation of complex fractionated atrial electrogram, and repeat ablation of any induced atrial tachycardias). Over 18-month follow-up, 59 % of group 1 patients remained in sinus rhythm without recurrent AF, compared to 64 % and 77 % in controls 1 and 2, respectively. The procedure time was longer in LPAF with a higher procedure complication risk in these 44 LPAF patients (5 % vs. 0 %) than in patients with paroxysmal AF. Our data suggest that catheter ablation provides a practical treatment option with moderate efficacy for restoring sinus rhythm in LPAF patients after failed DCCV.
Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA. luxxx074@umn.edu
Fei
F
Lü
Wayne O
WO
Adkisson
Taibo
T
Chen
Baris
B
Akdemir
David G
DG
Benditt
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004554:Electric Countershock; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure