10-Year Outcomes of Patients With Non-Paroxysmal Atrial Fibrillation Undergoing Catheter Ablation

• Published in: Circulation Journal 2022/09/22, pp.CJ-22-0062
• Main Authors: Tsai, Tsung-Ying, Lo, Li-Wei, Cheng, Wen-Han, Liu, Shin-Huei, Lin, Yenn-Jiang, Chang, Shih-Lin, Hu, Yu-Feng, Chung, Fa-Po, Liao, Jo-Nan, Tuan, Ta-Chuan, Chao, Tze-Fan, Lin, Chin-Yu, Chang, Ting-Yung, Liu, Chih-Min, Chheng, Chhay, Hermanto, Dony Yugo, An, Ton Nukhank, Elimam, Ahmed Moustafa Moustafa, Huang, Ting-Chun, Lee, Po-Tseng, Lee, Cheng-Hung, Chen, Shih-Ann
• Format: Article
• Language: English
• Subjects: Ablation; Anti-Arrhythmia Agents - therapeutic use; Atrial Appendage; Atrial Fibrillation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Heart Atria; Humans; Left atrium; Male; Middle Aged; Non-pulmonary vein; Outcomes; Pulmonary Veins - surgery; Recurrence; Retrospective Studies; Treatment Outcome
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-22-0062

Background: Radiofrequency catheter ablation (RFCA) is commonly performed in patients with non-paroxysmal atrial fibrillation (AF), but because very long-term follow-up results of RFCA are limited, we investigated the 10-year RFCA outcomes of non-paroxysmal AF.Methods and Results: We retrospectively enrolled 100 patients (89 men, mean age 53.5±8.4years) with drug-refractory symptomatic non-paroxysmal AF who underwent 3D electroanatomic-guided RFCA. Procedural characteristics at index procedures and clinical outcomes were investigated. In the index procedures, all patients had pulmonary vein isolation, 56 (56.0%), 48 (48.0%), and 32 (32.0%) underwent additional linear, complex fractionated atrial electrogram (CFAE) and non-pulmonary vein (NPV) foci ablations, respectively. After 124.1±31.7 months, 16 (16%) patients remained in sinus rhythm after just 1 procedure (3 with antiarrhythmic drugs [AAD]) and after multiple (2.1±1.3) procedures in 53 (53.0%) patients (22 with AAD). Left atrial (LA) diameter (hazard ratio HR 1.061; 95% confidence interval (CI) 1.020 to 1.103; P=0.003), presence of NPV triggers (HR 1.634; 95% CI 1.019 to 2.623; P=0.042) and undergoing CFAE ablation (HR 2.003; 95% CI 1.262 to 3.180; P=0.003) in the index procedure were independent predictors for recurrent atrial tachyarrhythmia.Conclusions: The 10-year outcomes of single RFCA in non-paroxysmal AF were unsatisfactory. Enlarged LA, presence of NPV triggers, and undergoing CFAE ablation in the index procedure independently predicted single-procedure recurrence. Multiple procedures are required to achieve adequate rhythm control.