title: Repeat Catheter Ablation of Long-standing Persistent Atrial Fibrillation in Patients with a Total Atrial Fibrillation Duration of More Than 2 Years: Effects of the CHA2DS2-VASc Score and Estimated Glomerular Filtration Rate on the Outcomes.
abstract: Objective Little is known about the outcome of repeat catheter ablation of long-standing persistent atrial fibrillation (AF) in patients with a total AF duration of more than 2 years. The main objective of this study was to explore the results and factors affecting the clinical success rate of these repeat procedures. Methods We enrolled 99 patients with a total AF duration of more than 2 years and recurrent atrial arrhythmias after the initial catheter ablation of long-standing persistent AF. The enrolled patients were divided into two groups named the AF-recurrence group (50 patients) and the atrial tachycardia (AT)-recurrence group (49 patients) and all underwent a strict follow-up. The quality of life (QOL) and AF-related symptom classification were assessed at baseline and at 24 months post re-ablation. Results After a mean follow-up of 31 months, 30 (30.3%) patients were free from arrhythmia recurrence, and the success rate in the AT-recurrence group was higher than that in the AF-recurrence group (32.7% vs. 28.0%, p=0.614). A Cox regression analysis revealed a CHA2DS2-VASc score ≥3 to be a predictor of recurrence. AF recurrent patients with an abnormal renal function were more prone to undergo a failed procedure. However, an abnormal renal function had no effect on the outcome of the repeat procedure for patients with AT recurrence. At the 24-month follow-up, patients maintaining sinus rhythm (SR) had a significantly improved QOL and AF-related symptoms. Conclusion The success rate of repeat procedures for long-standing persistent AF and a total AF duration of more than 2 years is poor for patients with a CHA2DS2-VASc score ≥3. An impaired renal function has an unfavorable effect on the outcome for patients with AF recurrence. For patients maintaining SR, both the QOL and AF symptomatology improve significantly.
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Shi-Li
authors.initials: SL
authors.lastname: Jiang
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.forename: Yi-Qing
authors.initials: YQ
authors.lastname: Yang
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications*; D018570:Risk Assessment; D013617:Tachycardia, Supraventricular / Q000150:complications*; D016896:Treatment Outcome