20 year - Clinical Outcome After Circumferential Pulmonary Vein Isolation in Patients with Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation

Melanie Anuscha Gunawardene (Hamburg)1, C.-H. Heeger (Lübeck)2, R. Wahedi (Hamburg)1, J. Hartmann (Hamburg)3, M. Jularic (Hamburg)1, Y. Steigerwald (Hamburg)1, F. Ouyang (Hamburg)4, K.-H. Kuck (Hamburg)5, R. R. Tilz (Lübeck)2, S. Willems (Hamburg)1

1Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 2Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; 3Asklepios Klinik St. Georg Interventionelle Kardiologie und Elektrophysiologie Hamburg, Deutschland; 4Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 5LANS Cardio Hamburg Kardiologie Hamburg, Deutschland


Background: In patients with paroxysmal atrial fibrillation (PAF), pulmonary vein isolation (PVI) is the cornerstone of catheter ablation. Data on 5- and 10-year clinical outcome of a PAF cohort have been reported before. However, further long-term data after circumferential PVI are sparse. We therefore investigated an extended long-term rhythm outcome after PVI in a PAF cohort after 20 years following index PVI. 

Objective: To evaluate long-term results of patients with PAF after PVI


Methods: From 2003 to 2004, 161 patients with symptomatic drug-refractory PAF were prospectively enrolled and underwent electroanatomical mapping–guided, circumferential PVI with irrigated radiofrequency current. The acute procedural endpoint was the absence of pulmonary vein spikes 30 minutes after PVI verified by 2 spiral catheters placed within the ipsilateral pulmonary veins (double lasso technique). A structured follow up of all patients (excluding a 90-day blanking period) was provided for the first 10 years, followed by regular telephone interviews and outpatient clinical visits including Holter ECGs and device interrogations, if applicable. Additional, 12-lead ECGs and Holter-ECGs were initiated in case of symptoms suggestive for recurrence of atrial arrhythmias (ATa). ECGs and Holter-ECGs performed duringfollow-up were collected and analysed. Recurrence was defined as symptomatic or asymptomatic episodes of ATa lasting >30 seconds. 



Results: Of an initially reported cohort of 161 PAF patients, 20 patients deceased. Of the remaining population long-term follow up of 246 ± 97 months was provided for a total of 59 patients (37%). 

Patients’ mean age at latest follow up was 80 ± 8 years. During follow up, single procedural success was 32% (19/59 without ATa recurrence after index PVI). 

A total of 32/59 (54%) patients underwent 2 ± 1 re-ablation procedures, leading to stable sinus rhythm without ATa recurrence since the last ablation procedure in 38/59 (64%) patients. Ten patients (10/59; 17%) progressed to persistent AF. A total of 14/59 (24%) patients were still on antiarrhythmic drugs and 20/59 (34%) were off oral anticoagulation. During follow up, five patients (5/59, 9%) suffered a thromboembolic event (n=5 strokes), one (1/59; 1.7%) patient received CPR and one (1/59; 1.7%) suffered from acute coronary syndrome. There were no major bleeding events. 

Conclusion: After 20 years of follow up, 64% of the remaining 59 patients from the initial PAF cohort were in stable sinus rhythm, including multiple ablation procedures and antiarrhythmic drugs. Remarkably, despite advanced age, about a third of patients were off OAC.

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