Atrial Fibrillation Often Recurs After Ablation

Two-thirds of patients with atrial fibrillation (AF) who underwent catheter ablation had recurrence during the first year after ablation, according to a new study.

Researchers at Beth Israel Deaconess Medical Center (Boston, MD, USA) evaluated the long-term outcomes of 153 catheter ablations in 103 AF patients with drug refractory AF (mean age 53, mean BMI 29 kg/m2, and more than three-quarters men); follow up was for six years. In all, 42 patients needed a second ablation, seven patients required a third ablation procedure, and one patient required a fourth ablation. Major bleeding followed 4% of all procedures, but there were no deaths, cerebrovascular (CV) events, or symptomatic pulmonary vein stenoses during follow-up. The researcher defined AF recurrence as atrial arrhythmia lasting more than 10 seconds.

The results showed that at one year after the last ablation, 63% of patients were free of all atrial arrhythmias; but by six years, that proportion had fallen to 39%. Of those who had more than one ablation procedure, the only predictor of recurrence was nonparoxysmal AF. After 62 ablation procedures, the patients were weaned off antiarrhythmic drugs, but AF recurred after 54 of those 62 cases (87%). The study was published early online on January 14, 2012, in the American Journal of Cardiology.

“Long-term results of catheter ablation for AF are somewhat disappointing compared with the short and medium-term ones,” said lead author Antonio Sorgente, MD. “Long-term free arrhythmia survival can be prolonged by not treating patients with nonparoxysmal AF, with enlarged atria, and with advanced cardiomyopathy; an accurate patient selection may help cardiac electrophysiologists reducing the rate of complications as well.”

AF may occur in episodes lasting from minutes to days (paroxysmal), or be permanent in nature (nonparoxysmal).

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Beth Israel Deaconess Medical Center