10-year clinical outcomes after radiofrequency catheter ablation for atrial fibrillation. A single center experience. (14th October 2021)

• Record Type: Journal Article
• Authors: Alderete Martinez, J.F; Shizuta, S; Yoneda, F; Nishiwaki, S; Tanaka, M; Komasa, A; Kohjitani, H; Yoshizawa, T; Kimura, T
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Rhythm Control, Catheter Ablation; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0518
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is becoming a routine procedure to treat patients with drug-refractory symptomatic AF. However, data regarding very long-term clinical outcomes is limited. The aim of the present study was to evaluate the 10-year clinical outcomes of patients who underwent RFCA for paroxysmal and persistent AF. Methods: We retrospectively enrolled 503 consecutive patients (mean age 66, 9±9, 51 years; 71, 6% male) who underwent RFCA for drug-refractory symptomatic AF between February 2004 and June 2011. Follow-up information was obtained using medical records and/or telephonic interviews with the patient, relatives and/or referring physicians. Results: Among 503 patients enrolled in this study, 362 had paroxysmal atrial fibrillation (PAF) and 141 had persistent atrial fibrillation (PeAF) (72% and 28%, respectively). Mean follow-up was 8, 84±3, 05 years. The 10-year event-free rate for recurrent atrial tachyarrhythmia (AT) after the first procedure was 44, 5% (49, 4% for PAF vs 31, 9% for PeAF; p=0, 002 by log-rank test) and 81, 9% after the last procedure (87, 3% for PAF and 67, 9% for PeAF; p≤0, 001 by log-rank test). AT recurrence was observed most commonly during the first 12 months of the initial procedure (56%), with only 18% of them occurring after 60 months. Multivariate analysis revealed that persistent AF (hazard ratio=1, 366; 95% confidence interval 1, 058–1, 76; p=0, 017) and duration of AF >5 years (hazard ratio=1, 357; 95% confidence interval 1, 064–1, 732; p=0, 005) were independent risk factors for AT recurrence. Regarding adverse events, there were 24 (4, 8%) hospitalizations for acute decompensated heart failure, 20 (4%) ischemic strokes and 14 (2, 8%) bleeding complications requiring hospital admissions. Patients taking oral anticoagulation and antiarrhythmic drugs at the end of the study accounted for 32, 8% and 16, 7% respectively. Conclusions: RFCA for AF provided favorable results in terms of arrhythmia event-free survival in long-term follow-up with better results in patients with paroxysmal AF. Persistent AF and long-standing AF (beyond 5 years) were associated with AT recurrence. Despite the large number of patients who discontinued oral anticoagulation, thromboembolic adverse events were rare. Funding Acknowledgement: Type of funding sources: None.