Long-term single- and multiple-procedure outcome and predictors of success after catheter ablation for persistent atrial fibrillation

Rostock, Thomas; Salukhe, Tushar V.; Steven, Daniel; Drewitz, Imke; Hoffmann, Boris A.; Bock, Karsten; Servatius, Helge; Müllerleile, Kai; Sultan, Arian; Gosau, Nils; Meinertz, Thomas; Wegscheider, Karl; Willems, Stephan

doi:10.1016/j.hrthm.2011.04.012

« Previous Next »Heart Rhythm
Volume 8, Issue 9 , Pages 1391-1397, September 2011

Long-term single- and multiple-procedure outcome and predictors of success after catheter ablation for persistent atrial fibrillation

Presented in part at the 31st Annual Scientific Sessions of the Heart Rhythm Society, which was held in Denver, Colorado, on May 12–15, 2010, and published in abstract form (Heart Rhythm 2010; Abstract Supplement).

Thomas Rostock, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
- Address reprint requests and correspondence: Thomas Rostock, M.D., University Hospital Eppendorf, University Heart Center, Department of Cardiology/Electrophysiology, Martinistrasse 52, D-20246 Hamburg, Germany
Tushar V. Salukhe, MRCP, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Daniel Steven, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Imke Drewitz, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Boris A. Hoffmann, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Karsten Bock, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Helge Servatius, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Kai Müllerleile, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Arian Sultan, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Nils Gosau, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Thomas Meinertz, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Karl Wegscheider, PhD
- Department of Biometrie and Epidemiology, Hamburg, Germany
Stephan Willems, MD
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany

Received 20 February 2011; accepted 4 April 2011. published online 14 April 2011.

Background

Stepwise ablation is an effective treatment for persistent atrial fibrillation (AF), although it often requires multiple procedures to eliminate recurrent arrhythmias.

Objective

This study evaluated single- and multiple-procedure long-term success rates and potential predictors of a favorable single-procedure outcome of stepwise ablation for persistent AF.

Methods

This study comprised 395 patients with persistent AF (duration 16 months) undergoing de novo catheter ablation using the stepwise approach. Procedural success was defined as the absence of any arrhythmia recurrence. Patient characteristics and electrophysiological parameters were analyzed with respect to single- and multiple-procedure outcomes.

Results

After a follow-up of 27 ± 7 months, 108 (27%) patients were free of arrhythmia recurrences with a single procedure. After 2.3 ± 0.6 procedures, 312 (79%) patients were free of arrhythmia with concomitant antiarrhythmic treatment in 38% (23% on β-blocker). Female gender, duration of persistent AF, and congestive heart failure were predictive for the outcome after first ablation. However, the strongest predictors for single-procedure success were longer baseline AF cycle length (CL) and procedural AF termination. Moreover, procedural AF termination during the index procedure also predicted a favorable outcome after the last procedure, while the existence of congestive heart failure was associated with an increased risk for eventual arrhythmia recurrences.

Conclusions

Single-procedure long-term success is anticipated in approximately a quarter of patients undergoing de novo ablation of persistent AF. Baseline AFCL emerged as the strongest predictor of single-procedure success, while AF termination during index ablation predicts the overall outcome. However, an overall success rate of 79% is achievable with multiple procedures.

Keywords: Atrial fibrillation, Catheter ablation, Termination, Outcome, Predictors

Abbreviations: AF, atrial fibrillation, AFCL, atrial fibrillation cycle length, AT, atrial tachycardia, CS, coronary sinus, ECG, electrocardiogram, LA, left atrium, LAA, left atrial appendage, PV, pulmonary veins, RA, right atrium, RAA, right atrial appendage, RF, radiofrequency, SR, sinus rhythm