Very long-term clinical outcomes after radiofrequency catheter ablation for atrial fibrillation: A large single-center experience

Abstract

Radiofrequency catheter ablation (RFCA) has become widely used for drug-refractory atrial fibrillation (AF). However, there is a paucity of data on the long-term clinical outcomes after RFCA for AF. The aim of the present study was to investigate the very long-term outcomes after RFCA for AF in a large number of consecutive patients. Methods and results: In this retrospective single-center study, we evaluated very long-term follow-up results in 1206 consecutive patients undergoing first RFCA for AF. The primary outcomes were adverse outcomes at 30-day as a safety outcome measure and event-free rates from recurrent atrial tachyarrhythmias as efficacy outcome measures. Final follow-up rate reached 99.3% with a mean follow-up duration of 5.0 ± 2.5 years. The incidence of overall 30-day adverse outcomes was 3.6% without death. The 10-year event-free rates from recurrent atrial tachyarrhythmias after the initial and last procedures were 46.9% and 76.4%, respectively. Arrhythmia recurrence occurred most commonly during the first year and decreased beyond 3-year, although it continued to occur at an annual rate of 2.0% and 1.3%, respectively, throughout the 10-year follow-up period. The cumulative 10-year incidences of stroke and major bleeding were 4.2% and 3.5%, respectively, with annual rates of 0.3%. Discontinuation rate of oral anticoagulation at 1-, 3-, and 10-year was 34.6%, 53.4%, 58.0% and 61.9%. Conclusions: RFCA for AF provided favorable very long-term arrhythmia-free survival without much safety concerns. The 10-year rates of stroke and major bleeding were low even with discontinuation of oral anticoagulation in a large proportion of patients.

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice?

“…Follow-up data beyond 5 or 10 years are limited, and suggest that 2-5% of "successfully" ablated patients will have recurrences annually. [117][118][119][120] Furthermore, many of these recurrences may be asymptomatic and the prognostic implication of asymptomatic episodes on both stroke risk and cognitive function is unknown. [121][122][123] Catheter ablation as a specific therapeutic approach to lower risk of stroke and dementia is discussed in the Catheter Ablation section.…”

Impact of Pre-Existing Bradycardia on Subsequent Need for Pacemaker Implantation After Radiofrequency Catheter Ablation for Atrial Fibrillation

“…The details of RFCA have been described elsewhere. 10 In brief, the procedure was performed under conscious sedation with propofol and/or dexmedetomidine. Activated clotting time was kept >300 s with unfractionated heparin after trans-septal puncture.…”

Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques – incidence and risk factors

“…Catheter ablation has become a standard therapeutic option in patients with symptomatic, drug-refractory atrial fibrillation (AF) [1][2][3]. Pulmonary vein isolation (PVI), confirmed with documented bidirectional conduction block between the left atrium (LA) and pulmonary veins (PVs), is the cornerstone of AF ablation [4].…”