title: Very long-term outcome after initially successful catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  The ablation of atrial fibrillation (AF) using pulmonary vein isolation is indicated when patients do not respond favorably to medical therapy. Successful procedures are accomplished in the majority of patients, but the outcome after many years of follow-up after ablation is unknown.
  
  
  OBJECTIVE
  To describe the long-term recurrence rate and pattern of AF after successful ablation.
  
  
  METHODS
  A prospectively identified cohort of 445 patients who demonstrated freedom from AF for at least 1 year postablation (single procedure in 391 [87.9%]) was followed for 66.0 ± 34.0 months. Patients were seen at least annually as outpatients and underwent regular electrocardiographic monitoring.
  
  
  RESULTS
  At 40.7 ± 27.0 months postablation, 97 (21.8%) patients experienced at least 1 episode of recurrent AF. The vast majority of events were symptomatic, and no serious clinical events were associated with AF recurrence (eg, stroke). There was a steady attrition rate reaching 16.3% and 29.8% at 5 and 10 years, respectively. In 29 patients (29.5%) of the patients, recurrences were self-limited; the remainder required either medical therapy or repeat ablation. By multivariate analysis, persistent AF (hazard ratio 3.08; P < .0001) and hypertension (hazard ratio 1.08; P = .009) were independent risk factors for the recurrence of AF. The presence of both factors placed the patient at high risk of recurrence: 37.6% at 5 years and 68.8% at 10 years.
  
  
  CONCLUSIONS
  Over the decade after a successful ablation of AF, most patients continue to demonstrate freedom from AF. At the highest risk of very late recurrence is the subset of patients with hypertension and prior persistent AF.
authors: Arrhythmia Institute, Valley Health System, New York, New York. Electronic address: jss7@columbia.edu.
authors: Jonathan S
authors: JS
authors: Steinberg
authors: Arrhythmia Institute, Valley Health System, New York, New York.
authors: Rachel
authors: R
authors: Palekar
authors: Arrhythmia Institute, Valley Health System, New York, New York.
authors: Tina
authors: T
authors: Sichrovsky
authors: Arrhythmia Institute, Valley Health System, New York, New York.
authors: Aysha
authors: A
authors: Arshad
authors: Arrhythmia Institute, Valley Health System, New York, New York.
authors: Mark
authors: M
authors: Preminger
authors: Arrhythmia Institute, Valley Health System, New York, New York.
authors: Dan
authors: D
authors: Musat
authors: Arrhythmia Institute, Valley Health System, New York, New York.
authors: Richard E
authors: RE
authors: Shaw
authors: Arrhythmia Institute, Valley Health System, New York, New York.
authors: Suneet
authors: S
authors: Mittal
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Freedom from recurrence; Pulmonary vein isolation; Risk factors for recurrence; Very late recurrence