title: Long-term progression from paroxysmal to permanent atrial fibrillation following transcatheter ablation in a large single-center experience.
abstract: BACKGROUND
  The natural history of atrial fibrillation (AF) is characterized by gradual increase in duration and frequency of relapses until a definitive shift to permanent AF. Heart disease and comorbidities modulate AF progression. However, to date the influence of catheter ablation on AF evolution has rarely been investigated.
  
  
  OBJECTIVE
  The purpose of this study was to identify long-term predictors of AF progression in a large cohort of patients undergoing AF transcatheter ablation (AFTCA).
  
  
  METHODS
  A total of 889 patients (mean age 57 ± 11 years; 53.3% paroxysmal AF, 40.5% persistent AF, 6.2% long-standing AF) underwent AFTCA. All patients underwent pulmonary vein isolation, with linear lesions and complex fractionated atrial electrogram ablation reserved for patients with persistent/long-standing AF and/or confirmed structural heart disease.
  
  
  RESULTS
  After median follow-up of 64 months (range 41-84 years), AF progression despite AFTCA occurred in 57 cases (6.4%). However, AF progression was much more pronounced in patients with persistent (10%) or long-standing persistent AF (14.6%) than in those with paroxysmal AF (2.7%, P <.001). Furthermore, AF progression was more frequently reported in patients who presented with underlying comorbidities/cardiomyopathies (9.1%) than in those who presented with lone AF (29.9%, P <.001). At multivariate analysis, comorbidities/cardiomyopathies and baseline persistent/long-standing AF proved to be independent predictors of progression (odds ratio 11.3, 95% confidence interval 2.6-48.0, P <.001, and odds ratio 1.6, 95% confidence interval 1.2-2.1, P <.001, respectively).
  
  
  CONCLUSIONS
  The presence of comorbidities/cardiomyopathies and persistent/long-standing AF seem to predict AF progression in patients undergoing AFTCA. Performing AFTCA in the paroxysmal phase of the arrhythmia may reduce progression of AF to its permanent form.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gallo
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Battaglia
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Sardi
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Gaido
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Garberoglio
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Giustetto
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Ferraris
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Toso
authors.affiliation: Division of Cardiology, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy. Electronic address: fiorenzo.gaita@unito.it.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Long-term progression; Permanent atrial fibrillation; Transcatheter ablation