Six Year Follow-Up After Catheter Ablation of Atrial Fibrillation: A Palliation More Than a True Cure

Sorgente, Antonio; Tung, Patricia; Wylie, Jack; Josephson, Mark E.

doi:10.1016/j.amjcard.2011.11.058

Cited by 70 publications

(48 citation statements)

References 11 publications

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“…31,32 Our ablation approach targeting non-PV triggers along with PVAI appeared to yield higher long-term success rate, which is in agreement with findings from earlier studies. [8][9][10]15,16 Study result of Sorgente et al 7 was more disappointing with a 6-year multiprocedure success rate of 50% in PAF patients which could be because of stricter definition of recurrence as well as their ostial ablation approach.…”

Section: Discussionmentioning

confidence: 91%

“…21 Few series have reported long-term outcomes of AF ablation over 5 years. 4,[6][7][8][9][10][12][13][14][15][16] However, data on long-term follow-up of PVAI are limited, which would provide valuable information regarding the efficacy and safety of CA and necessity of repeat procedures. Therefore, we sought to assess the outcome of PVAI in patients with PAF over a follow-up period of more than a decade.…”

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

“…3 Several published reports have provided information on the outcomes of AF ablation. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] A meta-analysis evaluating studies reporting >3 years of outcome after catheter ablation (CA) found that nearly 80% multiprocedure success rates can be achieved in patients with PAF. 21 Few series have reported long-term outcomes of AF ablation over 5 years.…”

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

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Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results-A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions-In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers. (Circ Arrhythm Electrophysiol. 2016;9:e003660.

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Section: Discussionmentioning

confidence: 91%

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

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Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…16 Also, the AF recurrence could not be identified after the procedure until the patient was later hospitalized attributable to AF. 28,29 Third, details on the AF history (ie, persistent versus paroxysmal and left atrial size) were not available in the claims database. Fourth, although it was reported that ablation was superior to antiarrhythmic drug treatment in improving quality of life scale, 30 quality of life was not measured.…”

Section: Discussionmentioning

confidence: 99%

Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

Chang

Lin

Chiu

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— This study examined the effect of radiofrequency catheter ablation (RFA) on reducing morbidity and mortality among patients with atrial fibrillation (AF). Methods and Results— A retrospective cohort of patients with AF without prior stroke or heart failure (HF) who underwent RFA between 2003 and 2009 was identified using Taiwan’s National Health Insurance claims database. Outpatients with AF who met the same enrollment criteria but did not receive RFA were matched (≤1:20) by hospitals and dates to serve as controls. Outcomes of interest were death, stroke, or hospitalization for HF. A proportional hazard Cox regression model adjusted by propensity scores (based on age, sex, hypertension, diabetes mellitus, comorbidities, medications, and medical resource utilization) was applied to estimate the hazard ratio and 95% confidence interval. A total of 846 patients with AF who received RFA and 11 324 matched AF controls were included, with a mean follow-up of 3.74 and 3.96 years, respectively. RFA was associated with a lower hazard for stroke (hazard ratio, 0.57; 95% confidence interval, 0.35–0.94; P =0.026). The reduction in the hazard for death and HF did not reach statistical significance (hazard ratio, 0.88; 95% confidence interval, 0.62–1.23; P =0.451 and hazard ratio, 0.78; 95% confidence interval, 0.55–1.12; P =0.185, respectively). Additional analysis using death as a competing risk showed similar results for stroke and HF. Conclusions— RFA did not reduce mortality or hospitalization for HF during the immediate 3.5-year follow-up. Although a beneficial effect on stroke prevention associated with RFA was suggested, residual confounding attributable to unmeasured factors remains a concern.

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“…Ablation has not, however, proven to be a panacea, with disappointing recurrence rates, particularly in persistent AF. 4 Pharmacotherapy of AF has provided promising progress and as our understanding of pathogenesis evolves, the paradigm has shifted towards preventative therapy.…”

Section: Introductionmentioning

confidence: 99%

Advances in the management of atrial fibrillation

Behr

2012

Clinical Medicine

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-Atrial fibrillation (AF) is the most common arrhythmia worldwide, increasing in incidence with the aging population. Substantial morbidity and mortality accompany its diagnosis. Management should focus on rate and rhythm management, on reducing thromboembolic risk, and also potentially on targeting the mechanisms responsible for its perpetuation. Current antiarrhythmic therapy has only modest efficacy and substantial side effects, and anticoagulation regimes are cumbersome and require regular monitoring. Novel anticoagulants and antiarrhythmics hold the promise of improved efficacy and safety. This review covers current therapy for AF, major advances in pharmacological management and future directions for therapy.

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Six Year Follow-Up After Catheter Ablation of Atrial Fibrillation: A Palliation More Than a True Cure

Cited by 70 publications

References 11 publications

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

Advances in the management of atrial fibrillation

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