title: Long-term outcomes of adjunctive complex fractionated electrogram ablation to pulmonary vein isolation as treatment for non-paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  The adjunctive ablation of areas of complex fractionated electrogram (CFE) to pulmonary vein isolation (PVI) is an emerging strategy for patients with non-paroxysmal atrial fibrillation (AF). We studied the long-term outcomes of this approach.
  
  
  METHODS
  Sixty-six patients (mean age 58 ± 9, 86.4 % male) with non-paroxysmal AF underwent ablation procedures consisting of PVI plus extensive CFE ablation. Post-ablation atrial tachycardia (AT) was also targeted if presented. All patients were followed up regularly on an ambulatory basis by means of ECG and Holter recordings.
  
  
  RESULTS
  After a mean follow-up period of 40 ± 14 months and 1.7 ± 0.7 procedures, 38 patients (57.6 %) were free of arrhythmias, 15 (22.7 %) displayed clinical improvement and 13 (19.7 %) suffered recurrences of persistent AF/AT. Females displayed poorer long-term outcomes than males (arrhythmia-free 22.2 vs. 63.2 %, p < 0.05). Multivariate analysis demonstrated that long duration of uninterrupted AF prior to the procedure was an additional predictor of long-term failure (odds ratio 1.49, p < 0.01). ROC analysis (area under curve 0.80; p < 0.001) estimated 3.5 years as the optimal cut-off point for predicting long-term failure (sensitivity 85 %, specificity 74 %). The cumulative data showed a significantly higher percentage of arrhythmia-free patients when the duration of AF had been ≤ 2 years (69.7 %) and ≤ 4 years (68.9 %) than when it was > 4 years (33.3 %; p < 0.01).
  
  
  CONCLUSIONS
  PVI + CFE ablation in non-paroxysmal AF appears to provide a reasonable proportion of arrhythmia-free patients during long-term follow-up. Poorer long-term results can be expected among female patients and those with an uninterrupted AF duration of > 4 years.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, 5021, Bergen, Norway.
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Bortoli
authors.forename: Ole-Jørgen
authors.initials: OJ
authors.lastname: Ohm
authors.forename: Per Ivar
authors.initials: PI
authors.lastname: Hoff
authors.forename: Li-Zhi
authors.initials: LZ
authors.lastname: Sun
authors.forename: Peter
authors.initials: P
authors.lastname: Schuster
authors.forename: Eivind
authors.initials: E
authors.lastname: Solheim
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011667:Pulmonary Veins / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D016896:Treatment Outcome