Long term outcomes from catheter ablation of very longstanding persistent atrial fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Catheter ablation success rates for longstanding persistent atrial fibrillation (AF) are lower than for paroxysmal or recent-onset forms.
• This study investigates long-term outcomes of catheter ablation for very longstanding persistent AF (duration > 2 years).

Purpose of the Study:

• To evaluate the long-term efficacy and outcomes of catheter ablation in patients with symptomatic very longstanding persistent AF.
• To assess the need for adjunctive therapies and repeat procedures in this patient cohort.

Main Methods:

• Retrospective analysis of 29 patients with symptomatic very longstanding persistent AF undergoing catheter ablation between 2008 and 2013.
• Follow-up duration averaged 61 months post-ablation.
• Procedures included antral pulmonary vein isolation, with some patients receiving additional lines and/or CFAE ablation.

Main Results:

• 83% of patients maintained sinus rhythm at long-term follow-up (mean 61 months).
• Only 31% remained free of detectable arrhythmia; 86% required antiarrhythmic therapy, and 62% needed DC cardioversions.
• The mean time to first AF recurrence was 14 months, with 45% undergoing redo ablation.
• Significant improvement in symptom scores (EHRA) was observed (p<0.0001).

Conclusions:

• Catheter ablation can maintain sinus rhythm in a majority of very longstanding persistent AF patients long-term.
• Adjunctive therapies, including antiarrhythmics, DC cardioversions, and repeat ablations, are frequently necessary.
• Despite the need for further interventions, ablation significantly improves symptom burden in this challenging patient group.