Long-term outcomes after catheter ablation of atrial fibrillation: single centre experience

Abstract

Background: Catheter ablation has been widely adopted for the treatment of atrial fibrillation (AF). We have already reported on early and mid-term ablation outcomes. Our aim is to report on long-term clinical outcomes.

Methods: We performed a follow-up on all patients in whom the first catheter ablation was performed between 2003 and 2009 due to antiarrhythmic drug-refractory paroxysmal or persistent AF. We also considered ablation procedures for typical atrial flutter (AU) performed after 1999. Complete electrical isolation of the pulmonary veins (PV) was the primary ablation target. The fluoroscopy and lasso-catheter guided segmental radiofrequency ablation procedure was performed. For typical AU, cavotricuspidal isthmus linear ablation was performed. Patients were followed up for at least 5 years after the complete PV isolation, up to a telephone call in April 2020, or death. They were classified as: a) successful, in stabile sinus rhythm with up to 5-minute mild palpitations, without regular antiarrhythmic drug (AAD) treatment, b) partially successful, mainly in sinus rhythm with rare AF/AU episodes up to once a year and periodic AAD treatment, and c) unsuccessful, with frequent AF/AU episodes despite AAD or with long-term persistent AF/AU. Ablation due to recurrent AF/AU was repeated only after a blanking of period of three months. Recurrent AF/AU was documented with serial ECGs or Holter monitoring. The results were evaluated by Kaplan-Meier analysis, t-test and Fisher’s test. P < 0.05 was considered significant.

Results: We included 128 patients (95 male, 33 female, median age at the first ablation procedure was 54.5 years, range 19–75 years). On average, 1.7 ablation procedures per patient for AF or 2 procedures per patient considering also AU ablations were done. The follow-up was successful in 117 patients (85 male, 32 female) on average for 11.7 years (median 140 months, range 21–230). Ten patients died (6 male, 4 female); death was not related to ablation procedure. The most frequent comorbidities were malignant disease and thyroid dysfunction. The probability of stabile sinus rhythm after 10 years of follow-up was 50%, with first-year drop of 15% and a linear drop of 4% per year afterwards. Ablation procedure was successful in 54 patients (46%), partially successful in 25 (21%) and unsuccessful in 38 patients (33%, worse in females, p < 0.05). Only 46 (16%) ablation procedures were performed over the last 10 years. Thirty-eight patients (32%) were treated with AADs, mainly with amiodarone and propafenone. Tamponade was the only serious complication in 5 patients (4%); none of them needed surgical intervention.

Conclusion: Catheter ablation of AF is a reasonably long-term successful, safe and, according to reported data, cost-efficient procedure, and therefore recommended for the majority of patients with AF. In addition, elimination of reversible risk factors, appropriate AAD treatment and anticoagulation are of great importance for thorough management of patients with AF.