title: Long-term follow-up after catheter ablation of paroxysmal atrial fibrillation: the incidence of recurrence and progression of atrial fibrillation.
abstract: BACKGROUND
  Although catheter ablation (CA) is a standard treatment for atrial fibrillation (AF), its long-term efficacy remains unclear. This study aimed to elucidate the incidences of AF recurrence and of progression from paroxysmal to persistent AF, after CA, in patients with paroxysmal AF.
  
  
  RESULTS
  We examined the incidence of AF recurrence and AF progression in 1220 consecutive patients (mean age, 61 years), with symptomatic paroxysmal AF, undergoing CA, based on extensive pulmonary vein isolation and focal ablation for nonpulmonary vein foci. AF recurrence-free survival probabilities at 5 years were 59.4% after the initial CA and 81.1% after the final CA (average, 1.3 procedures). During a median follow-up period of 47.9 (range, 5.3-123.3) months after the initial CA, AF progressed from paroxysmal to persistent in 15 (1.2%) patients (0.3%/y). The duration of AF history (hazard ratio [HR], 1.03; P<0.0001), number of ineffective antiarrhythmics (HR, 1.09; P=0.005), and left atrial diameter indexed by the body surface area (HR, 1.05; P=0.001) were significant predictors of AF recurrence. Patient age (HR, 1.12; P=0.0001) and left atrial diameter indexed by the body surface area (HR, 1.26; P=0.0006) were significantly associated with AF progression. Patients aged≤65 years and with a left atrial diameter indexed by the body surface area of ≤24.0 mm/m2 did not develop AF progression for ≤10 years after the initial CA.
  
  
  CONCLUSIONS
  Although the long-term follow-up revealed the effect of CA on preventing AF recurrence, repeated CA sessions might be required. The rate of progression from paroxysmal to persistent AF was 0.3%/y.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watari
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fujino
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013614:Tachycardia, Paroxysmal / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; recurrence