Insights into ablation of persistent atrial fibrillation: Lessons from 6-year clinical outcomes

Stephanie Brooks*, Andreas Metzner, Peter Wohlmuth, Tina Lin, Erik Wissner, Roland Tilz, Andreas Rillig, Shibu Mathew, Ardan Saguner, Christian Heeger, Christian Sohns, Karl Heinz Kuck, Feifan Ouyang

*Corresponding author for this work
22 Citations (Scopus)

Abstract

Introduction: Ablation of persistent atrial fibrillation (AF) is a potential treatment option for symptomatic patients. We sought to evaluate the critical role of circumferential pulmonary vein isolation (CPVI) in the ablation of persistent AF. Methods and results: A total of 341 ablation procedures were performed in 174 consecutive patients with persistent AF. CPVI was performed in all patients, additional ablation was only performed if electrical cardioversion failed after CPVI. During a median follow-up (FU) of 89 (63; 89) months, stable sinus rhythm was documented in 42/170 (25%) patients after a single procedure and in 111/164 (68%) patients after 1.9 ± 1.1 procedures. Stable SR was achieved in 40/75 (53%) patients in whom only CPVI was performed during the index and repeat procedures and in 71/89 (79%) patients with CPVI plus additional ablation. The main predictor for ablation success was duration of persistent AF before the index procedure (P < 0.001, HR ± CI: 1.608 [1.034, 1.103]). Responders to CPVI during the initial procedure had a significantly better multiple-procedure outcome after 42 months of FU compared to CPVI nonresponders (P = 0.0365). Conversion during the index procedure had no impact on clinical outcomes (P = 0.0903). Persistent AF regressed to paroxysmal AF in 16% of patients. Conclusions: We demonstrate a 25% single- and 68% multiple-procedure success in patients with persistent AF, while stable SR was achieved in 53% of patients with pure CPVI during all procedures and in 79% of patients with CPVI plus additional ablation. Only duration of persistent AF before ablation had a statistically significant impact on ablation outcome.

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
Volume29
Issue number2
Pages (from-to)257-263
Number of pages7
ISSN1045-3873
DOIs
Publication statusPublished - 02.2018

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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