title: Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint.
abstract: BACKGROUND
  This study aimed to determine 5-year efficacy of catheter ablation for persistent atrial fibrillation (AF) using AF termination as a procedural end point.
  
  
  RESULTS
  One hundred fifty patients (57±10 years) underwent persistent AF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided, and linear ablation) with the desired procedural end point being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia. AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3%±3.9%, 28.0%±3.7%, and 16.8%±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7%±2.5%, 79.8%±3.4%, and 62.9%±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (interquartile range, 43-73) months after the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs. Another 14 (9.3%) patients maintained sinus rhythm after reinitiation of antiarrhythmic drugs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (hazard ratio 3.831; 95% confidence interval, 2.070-7.143; P<0.001), left atrial diameter≥50 mm (hazard ratio 2.083; 95% confidence interval, 1.078-4.016; P=0.03), continuous AF duration≥18 months (hazard ratio 1.984; 95% confidence interval, 1.024-3.846; P<0.04), and structural heart disease (hazard ratio 1.874; 95% confidence interval, 1.037-3.388; P=0.04) predicted arrhythmia recurrence.
  
  
  CONCLUSIONS
  In patients with persistent AF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow-up period. Procedural AF nontermination and specific baseline factors predict long-term outcome after ablation.
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.). daniel.scherr@medunigraz.at.
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherr
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Valerie
authors.initials: V
authors.lastname: Aurillac-Lavignolle
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pascale
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Wilton
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Khaled
authors.initials: K
authors.lastname: Ramoul
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Laurent
authors.initials: L
authors.lastname: Roten
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Amir
authors.initials: A
authors.lastname: Jadidi
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Nick
authors.initials: N
authors.lastname: Linton
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Michala
authors.initials: M
authors.lastname: Pedersen
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Daly
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Mark
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Sebastien
authors.initials: S
authors.lastname: Knecht
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Martin
authors.initials: M
authors.lastname: Manninger
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Sunthareth
authors.initials: S
authors.lastname: Yeim
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.affiliation: From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O'N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: ablation; atrial fibrillation; atrial tachycardia