Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint

Abstract

Procedural termination of long-lasting AF by catheter ablation alone is associated with an improved outcome.

Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

“…The outcomes of the stepwise ablation approach have also been reported in three additional patient series from the same group 34,35,37 . Sacher et al 37 enrolled 43 persistent/long-standing persistent AF patients (AF mean 11 months, ranging from 1 month to 6 years) who underwent the same extensive ablation procedure.…”

“…Five studies have reported the clinical success associated with the stepwise ablation approach for persistent/long-standing persistent AF [34][35][36][37][38] . Haissiguerre and colleagues described the stepwise ablation approach in 60 persistent/long-standing persistent AF patients with regards to critical structures for acute AF slowing or termination and long term clinical outcome 38 .…”

“…The largest and most recent case series of 153 patients 35 demonstrated that the stepwise ablation approach was associated with a single procedure clinical success of 48%, with antiarrhythmic medication and multiple procedures increasing this to 89%. Taken together, these studies demonstrate a variance of 48 to 62% with a single procedure from a single centre with a well established ablation protocol and potential sample redundancy.…”

Ablation of Atrial Fibrillation

“…Until recent advances in mapping, ablation of AF "substrate" was synonymous with extensive lesions, with variable results 19,[60][61][62] and damage to atrial function 63 . One perceptible trend is to perform less extensive AF ablation, because widespread ablation may increase complications and reduce atrial function 63 , from the disappointing efficacy of extensive ablation of complex fractionated electrograms 19,61,62 and from mechanistic trends to identify targets amenable to localized ablation lesions.…”

AF Termination: the Holy Grail of Persistent AF Ablation?

“…Laboratories using this approach reported high long term success rate in up to 88% without anti-arrhythmic drugs despite the need for multiple procedures due to recurrent atrial tachycardias. [3][4][5][6] Specifically, from a prospective study of 153 consecutive patients, O'Neill and co-workers demonstrated that 95% of those with AF termination remained in sinus rhythm at a mean follow-up duration of 32 months as compared to just 52% in those without AF termination following repeat ablation procedures. 6 Likewise, in a smaller series of 88 patients by Rostock et al the overall success rate was 95% in those with as compared to 5% in those without termination of AF in two procedures and a mean follow-up duration of 20 months.…”