Natural History and Long-Term Outcomes of Ablated Atrial Fibrillation

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 4; no. 3; pp. 271 - 278
• Main Authors: Hussein, Ayman A, Saliba, Walid I, Martin, David O, Bhargava, Mandeep, Sherman, Minerva, Magnelli-Reyes, Christina, Chamsi-Pasha, Mohammed, John, Seby, Williams-Adrews, Michelle, Baranowski, Bryan, Dresing, Thomas, Callahan, Thomas, Kanj, Mohamed, Tchou, Patrick, Lindsay, Bruce D, Natale, Andrea, Wazni, Oussama
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.06.2011; Lippincott Williams & Wilkins
• Subjects: Antiarythmic agents; Atrial Fibrillation - etiology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular system; Catheter Ablation - methods; Female; Follow-Up Studies; Heart; Heart Rate - physiology; Humans; Male; Medical sciences; Middle Aged; Neurology; Pharmacology. Drug treatments; Prospective Studies; Pulmonary Veins - surgery; Recurrence; Time Factors; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Conduction; Recurrence; Isoprenaline; Relapse; Prognosis; Arrhythmia; Right; Cardiovascular disease; History; Natural; Epidemiology; Case history; Recovery; Result; Vascular disease; Prevention; Prospective; Trigger; Heart disease; Cerebrovascular disease; Pulmonary vein; Human; Nervous system diseases; Stroke; Late; Atrial fibrillation; Use; Patient; Method; Ablation; In vitro; Long term; Excitability disorder; Cerebral disorder; Follow up study; Professional practice; Central nervous system disease; Isolation; Early; Technique; long-term outcomes
• ISSN: 1941-3149; 1941-3084
• DOI: 10.1161/CIRCEP.111.962100

BACKGROUND—Atrial fibrillation (AF) ablation is increasingly used in clinical practice. We aimed to study the natural history and long-term outcomes of ablated AF. METHODS AND RESULTS—We followed 831 patients after pulmonary vein isolation (PVI) performed in 2005. We documented clinical outcomes using our prospective AF registry with most recent update on this group of patients in October 2009. In the first year after ablation, 23.8% had early recurrence. Over long-term follow-up (55 months), only 8.9% had late arrhythmia recurrence defined as occurring beyond the first year after ablation. Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6%. At last follow-up, clinical improvement was 89.9% (79.4% arrhythmia-free off antiarrhythmic drugs and 10.5% with AF controlled with antiarrhythmic drugs). Only 4.6% continued to have drug-resistant AF. It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation (CHADS score ≤2, stroke incidence of 0.06% per year). The procedure-related complication rate was very low. CONCLUSIONS—Pulmonary vein isolation is safe and efficacious for long-term maintenance of sinus rhythm and control of symptoms in patients with drug-resistant AF. It obviates the need for antiarrhythmic drugs, negative dromotropic agents, and anticoagulants in a substantial proportion of patients.