CardioExchange Archive

Long-term results after catheter ablation for AF are decidedly mixed, according to the longest study yet to follow patients after the procedure. In a report in the Journal of the American College of Cardiology, Rukshen Weerasooriya and colleagues followed 100 patients treated at a French hospital for 5 years. After a single procedure, the rates of arrhythmia-free survival were 40% at 1 year, 37% at 2 years, and 29% at 5 years. Patients underwent a median of 2 procedures during the study period. Following the last catheter ablation procedure, the rates of arrhythmia-free survival were 87% at 1 year, 81% at 2 years, and 63% at 5 years. Three patients had cardiac tamponade requiring drainage during the procedure. Patients with long-standing persistent AF were more likely to have a recurrence than other patients.

Results in the real world may be even worse than those reported in the study since, the authors noted, their “study population was not representative of patients with AF at large, as it consisted predominantly of younger, healthier, nonobese patients with relatively smaller atria and paroxysmal or recent progression to persistent AF.”

The authors concluded: “Although most recurrences transpire over the first 6 to 12 months, a slow but steady decline in arrhythmia-free survival is noted thereafter, even after 3 or more years of apparent arrhythmia control. Such long-term follow-up data should be openly discussed with patients, factored into management decisions, and incorporated into cost-effectiveness models that assess the merits of an ablation approach.”