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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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Characteristics, trends, and outcomes of ablation for persistent atrial fibrillation: a Danish cohort study

Lise Da Riis-Vestergaard1, Jacob Tønnesen2, Martin H Ruwald1

  • 1Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen O, Denmark.

European Heart Journal Open
|November 27, 2025
PubMed

Insights

Pulmonary vein isolation plus (PVI plus) catheter ablation for persistent atrial fibrillation (peAF) showed higher recurrence rates and decreased use over time. Complication rates remained low and similar between PVI and PVI plus strategies.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Catheter ablation (CA) is a standard treatment for atrial fibrillation (AF).
  • Pulmonary vein isolation (PVI) alone is less effective for persistent AF (peAF) compared to paroxysmal AF (PAF).
  • Limited real-world data exists on patient selection, outcomes, and complications for PVI versus PVI plus strategies in peAF.

Purpose of the Study:

  • To examine patient characteristics, trends, recurrence rates, and complications associated with PVI and PVI plus ablation strategies in patients with peAF.
  • To compare outcomes between PVI and PVI plus strategies in a real-world setting.
  • To analyze temporal trends in the utilization of PVI plus strategies for peAF.

Main Methods:

  • Retrospective analysis of the Danish National Ablation Database (2010-2020).
  • Inclusion of patients with peAF undergoing first-time catheter ablation.
  • Categorization into PVI or PVI plus ablation strategies, with assessment of baseline characteristics, AF recurrence (1 and 5 years), major adverse cardiovascular events (MACE), and complications.

Main Results:

  • A total of 4144 peAF patients were analyzed (3417 PVI, 727 PVI plus).
  • The PVI plus group exhibited longer diagnosis-to-ablation times and more severe atrial enlargement.
  • AF recurrence was higher with PVI plus (54% vs. 46% at 1 year, 77% vs. 68% at 5 years), though recurrence rates declined over time for both groups.
  • PVI plus utilization decreased significantly from 58% to 15% during the study period.
  • MACE and complication rates were low and comparable between the two strategies.

Conclusions:

  • PVI plus was associated with poorer outcomes and decreased utilization over time in peAF patients.
  • Longer diagnosis-to-ablation times and more severe atrial enlargement characterized patients undergoing PVI plus.
  • Despite differences in utilization and patient characteristics, complication rates were similar and low for both PVI and PVI plus strategies.
Abstract

Keywords:
Ablation strategyCatheter ablationPersistent atrial fibrillationPulmonary vein isolation

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