Long‐Term Outcome Following Successful Pulmonary Vein Isolation: Pattern and Prediction of Very Late Recurrence

Abstract

Although most patients following PVI remain AF-free, some patients develop "late" recurrence of AF. The "late" recurrence patients are more likely to have hypertension and hyperlipidemia. Most late recurrences are associated with PV reconnections. Our observations emphasize the importance of continued long-term vigilance for AF recurrence, and also raise concerns regarding the need for long-term anticoagulation therapy.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…268,282,283,284,285,286,287,288,289,290,291,292,293,294,295,296,297,298 A recent meta-analysis identified 16 studies involving 5864 individuals reporting on the link between obesity and recurrence of AF after catheter ablation, identifying that there was a 3.1% greater risk of recurrent AF postablation for every one unit increase in BMI (RR 1.03; 95% CI 1.00–1.07). 299 …”

Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?

“…Many factors (type of AF, LA size, age, sleep apnea and obesity, hypertension, LA fibrosis detected by magnetic resonance imaging, diabetes, a rise in right atrium magnetic strength) have been proposed as predictors of a poorer outcome after PVI [18,19] but the discrepancies among authors [20][21][22][23][24][25] showed the complicated nature of already ablated atrial tissue. We applied a combined ALARMEc risk score which effectively discriminates patient outcome after any ablation procedure [4,5].…”

Management of the Asymptomatic Patient After Catheter Ablation of Atrial Fibrillation

“…22,25 However, as documented by Shah and colleagues, late AF recurrences can occur, even after several years of apparent freedom from AF following ablation. 9 Thus, the optimal anticoagulation strategy following AF ablation needs to be tailored to the individual risks and preferences of the patient. Three series have examined the safety of discontinuing warfarin following AF ablation.…”

“…6 Studies using prolonged external monitoring after AF ablation have found a significant incidence of asymptomatic AF after ablation, and recent studies have shown that late recurrences of AF can continue to occur even five years after the initial ablation procedure. [7][8][9] The guidelines state that discontinuation of warfarin should be based on the patients CHADS 2 score rather than freedom from AF recurrence. 2,10 Importantly, two recent multicenter reviews from Cappato and colleagues have described a 6% incidence of major complications from AF ablation, including a 1/1000 risk of death.…”