Long term outcomes from catheter ablation of very longstanding persistent atrial fibrillation

Introduction: Success rates for catheter ablation of longstanding persistent atrial fibrillation (AF) are significantly poorer than for recently persistent or paroxysmal forms. We report on single centre long term outcomes from ablation of very longstanding (> 2years) persistent AF.

Material and methods: A retrospective analysis of outcomes for patients undergoing catheter ablation for symptomatic very longstanding persistent AF between 2008 and 2013 was performed.

Results: Twenty-nine patients were followed for a mean of 61±15months following the index ablation procedure. The mean duration of persistent AF prior was 64±51months (range 24-200), mean age 61±6years and mean CHA₂DS₂-VASc score 1.1±1.2. Antral pulmonary vein electrical isolation only was performed in 14 (48%) with the remainder having additional lines and/or CFAE ablation also. At last follow-up 24 (83%) were in sinus rhythm but only 9 (31%) remained free of detectable arrhythmia, 25 (86%) were taking antiarrhythmic therapy and 18 (62%) required intermittent DC cardioversions. The mean time to first AF recurrence was 14±14months (range 2-48). Redo ablation was required in 13 (45%) at a mean follow-up time of 15±12months. The mean EHRA score improved from 3.5±0.5 to 1.4±0.4 (p<0.0001).

Conclusions: The vast majority (83%) of very longstanding persistent AF patients maintained sinus rhythm at a mean follow-up time of 5years following catheter ablation, associated with a significant improvement in symptom scores. Adjunctive therapies including antiarrhythmics, DC cardioversions and redo ablation were required in most patients.