title: Recurrence after "long-term success" in catheter ablation of paroxysmal atrial fibrillation.
abstract: BACKGROUND
  The latest guidelines define "long-term success" as freedom from atrial arrhythmia recurrence more than 36 months after procedures without any antiarrhythmic drug therapy.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the clinical outcomes and procedural findings in patients with recurrence beyond "long-term success."
  
  
  METHODS
  Among patients who underwent pulmonary vein (PV) antrum isolation for drug-refractory symptomatic paroxysmal atrial fibrillation (AF), 37 in whom recurrent arrhythmias were observed during annual follow-up after "long-term success" and who underwent repeat procedures for recurrent arrhythmias were included in the study.
  
  
  RESULTS
  The time from the latest procedure to recurrence was a median of 61 ([25th, 75th percentiles]: [51-77.5]) months. Recurrent arrhythmia type was paroxysmal in 22 patients (59.5%) and persistent in 15 (40.5%). Recurrent arrhythmias were atrial tachycardia (AT) in 13 patients (35.1%), including 8 with AT unrelated to PVs. Repeat procedures were performed a median of 2.0 [1.0-4.0] months after identifying recurrent episodes. Recovered PV conduction was found in 29 patients (78.4%) and non-PV foci in 4 (10.8%). Freedom from recurrence 1 year after repeat procedures was 63.3%. Seven patients (18.9%) underwent further repeat procedures a median of 7.0 [2.0-28.0] months after repeat procedures and had no PV reconnections. In total, AF/AT unrelated to PVs was present in 24 patients (64.9%). In contrast, arrhythmias related to PVs were observed in 2 patients (5.4%) during a total of 46 repeat procedures after "long-term success."
  
  
  CONCLUSIONS
  Although PV reconnections were commonly found even after "long-term success," AF/AT unrelated to PVs was assumed to be present in the majority of this population.
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Eisuke
authors: E
authors: Usui
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan. Electronic address: mshinsuke@k3.dion.ne.jp.
authors: Shinsuke
authors: S
authors: Miyazaki
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Hiroshi
authors: H
authors: Taniguchi
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Noboru
authors: N
authors: Ichihara
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Yoshihisa
authors: Y
authors: Kanaji
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Takamitsu
authors: T
authors: Takagi
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Jin
authors: J
authors: Iwasawa
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Akio
authors: A
authors: Kuroi
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Hiroaki
authors: H
authors: Nakamura
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Hitoshi
authors: H
authors: Hachiya
authors: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Mitsuaki
authors: M
authors: Isobe
authors: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Kenzo
authors: K
authors: Hirao
authors: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors: Yoshito
authors: Y
authors: Iesaka
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D013995:Time; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Long-term success; Pulmonary vein isolation; Very late recurrence