Very long term outcomes of atrial fibrillation ablation

doi:10.1016/j.hrthm.2023.02.002

Arrhythmias & electrophysiology

Very long term outcomes of atrial fibrillation ablation

Heart RhythmPublished 9 Feb 2023Cohort study

Read the original article ↗PubMed

Cite

Authors' conclusion

After year 2, there is 2%/yr recurrence rate for all AF types. Ablation success is best in the CF catheter era, intermediate in the OIT era, and worst in the SBT era. Over the ablation eras, outcomes improved for PAF and PeAF but not for LsAF.

Study context

Population: Patients undergoing atrial fibrillation (AF) ablation (paroxysmal 33.6%, persistent 56.4%, long-standing 9.9%)
Participants: 5,200 patients7,145 ablation procedures

Exposure: Ablation eras by initial catheter: Contact force (CF) vs open irrigated tip (OIT) vs solid big tip (SBT)
CFn = 2,956
OITn = 2,143
SBTn = 101reference
Outcome: Freedom from AF after single and multiple ablation procedures
Follow-up: 5, 10 and 15 years

Main finding

As reported in the abstract

AF freedom at 5, 10, 15 years

Initial ablation, PAF (5/10/15 y): 67.8%, 56.3%, 47.6%
Initial ablation, PeAF (5/10/15 y): 46.6%, 35.6%, 26.5%
Initial ablation, LsAF (5/10/15 y): 30.4%, 18.0%, 3.4%
Final ablation, PAF (5/10/15 y): 80.3%, 72.6%, 62.5%
Final ablation, PeAF (5/10/15 y): 60.1%, 50.2%, 42.5%
Final ablation, LsAF (5/10/15 y): 43.4%, 32.0%, 20.6%

Observational data: associations, not effects.

Further findings

Outcome	P value
Outcomes by catheter era, PAF and PeAFCF vs OIT · CF better	P < 0.0001
Outcomes by catheter era, PAF and PeAFCF and OIT vs SBT · both better than SBT	P < 0.001

Outcomes by catheter era, PAF and PeAF

LsAF: no outcome improvement over the eras

Success after final ablation, by catheter era (CF, OIT, SBT) · 8 years

PAF (CF, OIT, SBT): 79.1%, 71.8%, 60.0%
PeAF (CF, OIT, SBT): 55.9%, 50.7%, 38.0%
LsAF (CF, OIT, SBT): 42.7%, 36.2%, 31.8%

AF recurrence over time · 2 to 15 years

Highest recurrence in first 2 years; 2- to 15-year recurrence: 2%/yr

Success predictors

Younger age, smaller left atrium, shorter AF duration, male sex, less persistent AF, lower CHA2DS2-VASc, fewer drugs failed, more recent catheter era

Original publication

Very long term outcomes of atrial fibrillation ablation. Heart Rhythm. Published 9 February 2023. doi:10.1016/j.hrthm.2023.02.002

Read the original article ↗

Composed by AI from the published abstract and checked against it. How Briefs are made →