Background
Little is known about the very long term durability of atrial fibrillation (AF) ablation.
Objective
The purpose of this study was to evaluate very long term AF ablation outcomes.
Methods
We followed 5200 patients undergoing 7145 ablation procedures. We evaluated outcomes
after single and multiple ablation procedures for paroxysmal (PAF; 33.6%), persistent
(PeAF; 56.4%), and long-standing (LsAF; 9.9%) AF. We compared 3 ablation eras by initial
ablation catheter: early (101 patients) using solid big tip (SBT) catheters (October
2003 to December 2005), intermediate (2143 patients) using open irrigated tip (OIT)
catheters (December 2005 to August 2016), and contemporary (2956 patients) using contact
force (CF) catheters (March 2014 to December 2021).
Results
AF freedom at 5, 10, and 15 years was as follows: initial ablation: PAF 67.8%, 56.3%,
47.6%; PeAF 46.6%, 35.6%, 26.5%; and LsAF 30.4%, 18.0%, 3.4%; final ablation: PAF
80.3%, 72.6%, 62.5%; PeAF 60.1%, 50.2%, 42.5%; and LsAF 43.4%, 32.0%, 20.6%. For PAF
and PeAF, CF ablation procedures were better than OIT ablation procedures (P < .0001) and both were better than SBT ablation procedures (P < .001). LsAF had no outcome improvement over the eras. The 8-year success rate after
final ablation for CF, OIT, and SBT catheter eras was as follows: PAF 79.1%, 71.8%,
60.0%; PeAF 55.9%, 50.7%, 38.0%; and LsAF 42.7%, 36.2%, 31.8%. Highest AF recurrence
was in the first 2 years, with a 2- to 15-year recurrence of 2%/yr. Success predictors
after initial and final ablation procedures were younger age, smaller left atrium,
shorter AF duration, male sex, less persistent AF, lower CHA2DS2-VASc score, fewer drugs failed, and more recent catheter era.
Conclusion
After year 2, there is 2%/yr recurrence rate for all AF types. Ablation success is
best in the CF catheter era, intermediate in the OIT era, and worst in the SBT era.
Over the ablation eras, outcomes improved for PAF and PeAF but not for LsAF. We should
follow patients indefinitely after ablation. We need an understanding of how to better
ablate more persistent AF.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 08, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: This research did not receive any funding from agencies in the public, private, or not-for-profit sectors.
Disclosures: Dr Mead has received consulting fees from Medtronic and iRhythm. Dr Salcedo has received consulting fees from Abbott, Biosense Webster, and Medtronic. Dr Brodt has received consulting fees from AtriCure, Biotronik, and Medtronic. Ms Lebsack has equity in Abbott and Boston Scientific. The rest of the authors report no conflicts of interest.
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