Heart Rhythm
Volume 6, Issue 10 , Pages 1403-1412, October 2009

Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: Results from a multicenter study

  • Mandeep Bhargava, MD

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • Dr. Mandeep Bhargava and Dr. Luigi Di Biase made equivalent contributions in the drafting of the manuscript, and both should be considered as first author.
    • ,
  • Luigi Di Biase, MD

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
    • Department of Cardiology, University of Foggia, Foggia, Italy
    • Dr. Mandeep Bhargava and Dr. Luigi Di Biase made equivalent contributions in the drafting of the manuscript, and both should be considered as first author.
    • ,
  • Prasant Mohanty, MBBS, MPH

      Affiliations

    • Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
    • ,
  • Subramanyam Prasad, MD

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • ,
  • David O. Martin, MD, MPH

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • ,
  • Michelle Williams-Andrews, RN

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • ,
  • Oussama M. Wazni, MD

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • ,
  • J. David Burkhardt, MD

      Affiliations

    • Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
    • ,
  • Jennifer E. Cummings, MD

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • ,
  • Yaariv Khaykin, MD

      Affiliations

    • Southlake Regional Health Center, Newmarket, Ontario, Canada
    • ,
  • Atul Verma, MD

      Affiliations

    • Southlake Regional Health Center, Newmarket, Ontario, Canada
    • ,
  • Steven Hao, MD

      Affiliations

    • California Pacific Medical Center, San Francisco, California
    • ,
  • Salwa Beheiry, RN

      Affiliations

    • California Pacific Medical Center, San Francisco, California
    • ,
  • Richard Hongo, MD

      Affiliations

    • California Pacific Medical Center, San Francisco, California
    • ,
  • Antonio Rossillo, MD

      Affiliations

    • Umberto I Hospital, Mestre-Venice, Italy
    • ,
  • Antonio Raviele, MD

      Affiliations

    • Umberto I Hospital, Mestre-Venice, Italy
    • ,
  • Aldo Bonso, MD

      Affiliations

    • Umberto I Hospital, Mestre-Venice, Italy
    • ,
  • Sakis Themistoclakis, MD

      Affiliations

    • Umberto I Hospital, Mestre-Venice, Italy
    • ,
  • Kelly Stewart, RN

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • ,
  • Walid I. Saliba, MD

      Affiliations

    • Cleveland Clinic, Cleveland, Ohio
    • ,
  • Robert A. Schweikert, MD

      Affiliations

    • Akron General Medical Center, Akron, Ohio
    • ,
  • Andrea Natale, MD, FACC, FHRS

      Affiliations

    • Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
    • Stanford University, Palo Alto, California
    • Case Western Reserve University, Cleveland, Ohio
    • Corresponding Author InformationAddress reprint requests and correspondence: Andrea Natale, MD, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 1015 32nd Street, Austin, Texas 78705

Received 29 March 2009; accepted 5 June 2009. published online 10 June 2009.

Background/Objective

The purpose of this prospective multicenter study was to compare results of catheter ablation in patients with paroxysmal atrial fibrillation (PAF) and those with nonparoxysmal atrial fibrillation (NPAF). The impact and the role of repeat catheter ablation were assessed in patients with recurrence.

Methods/Results

One thousand four hundred four patients underwent catheter ablation for atrial fibrillation (AF) performed by 12 operators at four institutions using a single technique guided by intracardiac echocardiography. Of these patients, 728 had PAF and 676 had NPAF. Among the NPAF patients, 293 had persistent AF and 383 had long-standing persistent AF. Patients with NPAF had a higher incidence of hypertension and/or structural heart disease (64.8% vs 48.5%, P = .003) and a lower mean left ventricular ejection fraction (53.3% ± 8.7% vs 55.7 ± 6.5%, P <.001). All patients underwent antral isolation of all four pulmonary veins and the superior vena cava. At mean follow-up of 57 ± 17 months, 565 of 728 patients with PAF and 454 of 676 patients with NPAF (77.6% vs 67.2%, P <.001) had freedom from AF after a single ablation procedure. For arrhythmia recurrences, 74.2% (121/163) patients with PAF and 74.8% (166/222) with NPAF underwent repeat ablation, after which 92.4% patients with PAF and 84.0% patients with NPAF remained free from AF.

Conclusion

Pulmonary vein antrum isolation guided by intracardiac echocardiography results in significant freedom from AF, even when performed by multiple operators in different centers. At least moderate efficacy can be achieved in patients with NPAF, although the success rate is lower than in patients with PAF. Considerably higher success can be achieved in both groups with repeat ablation.

Keywords: Atrial fibrillation, Catheter ablation, Nonparoxysmal, long-standing persistent atrial fibrillation

 

PII: S1547-5271(09)00637-7

doi:10.1016/j.hrthm.2009.06.014

Heart Rhythm
Volume 6, Issue 10 , Pages 1403-1412, October 2009

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