Clinical Outcome of Catheter Ablation in Patients With Nonparoxysmal Atrial Fibrillation

Abstract

Background-Catheter ablation of atrial fibrillation (AF) became an effective therapy for patients with drug-refractory AF, and the indications have broadened to include nonparoxysmal AF patients. However, data about the long-term effectiveness of ablation in patients with nonparoxysmal AF are lacking. The aim of the present study was to investigate the long-term outcomes of catheter ablation in patients with nonparoxysmal AF. Methods and Results-A total of 88 nonparoxysmal AF patients who received a stepwise catheter ablation (isolation of the pulmonary veins plus substrate modification) from 2006 to 2008 were enrolled. Freedom of recurrence was defined as the absence of atrial arrhythmias without using any antiarrhythmic agents after the catheter ablation. There were 63 patients (71.6%) with recurrences (47 patients with AF and 16 patients with atrial flutter/atrial tachycardia) after the initial procedure during a median follow-up period of 36.8 months. A CHADS 2 score of ≥3 and the left atrial (LA) diameter were significant predictors of recurrences in the multivariable analysis. Of the patients with CHADS 2 scores of ≥3 and an LA dimension ≥44 mm, all had recurrences within 1 year after the initial procedure. The overall recurrence-free rate could increase to 47.7% after the second procedure and 51.1% after the third procedure. Conclusions-The long-term recurrence-free rate of ablation in nonparoxysmal AF was only 28.4% after a single procedure, and multiple procedures were necessary to raise the recurrence-free rate. The CHADS 2 score and LA dimension may help us to identify patients who will have recurrences after catheter ablations of nonparoxysmal AF.(Circ Arrhythm Electrophysiol. 2012;5:514-520.)

Endothelial–mesenchymal transition in human atrial fibrillation

“…In our study population, the amount of fibrotic deposition in LA was correlated with LAD, which is a strong predictor of recurrence of AF after catheter ablation or drug therapy [2,11]. Interstitial fibrosis separates cardiomyocytes, which interferes with electric continuity and slows the electrical conduction and thereby causes the progression of AF to permanent forms [3].…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…However, late recurrences are common and associated with more advanced atrial substrate associated with structural heart disease. [436][437][438][439][440][441][442][443][444][445][446] It is in this context that it is important to consider the various types of underlying atrial cardiomyopathy and how they may affect ablation outcomes. This is timely, as it has recently been observed that lone AF is a rapidly disappearing entity as we recognize conditions such as sleep apnoea, obesity, endurance exercise etc.…”

Nationwide Survey of Catheter Ablation for Atrial Fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF)

“…Thanks to technological and technical progress, pAF and LS-pAF with preserved cardiac structure can also be treated by ablation, if patients prefer that choice. 14, 15 It is important to rationally select patients whose AF substrate is likely to be cured by PVI and/or by some supplemental ablation at sites other than the PV antrum. The LA size is known as 1 determinant of successful ablation, 16 and in the present study, although the mean LAd of the 3 AF types was statistically different, the LA in nonPAF patients was not markedly enlarged (mean: 42.8 mm and 44.7 mm).…”