Catheter ablation effective long term for treatment of AF
MedWire News: Catheter ablation is an effective long-term treatment for restoring sinus rhythm in both persistent (Pe) and paroxysmal (P) atrial fibrillation (AF) patients, show study results.
Additional complex or fractionated electrogram (CFE) targeting may further improve outcome for PeAF patients, report the researchers.
Catheter ablation has been shown to be an effective technique for restoring sinus rhythm in AF patients in previous studies, but follow-up has been limited and there are few data on long-term outcomes.
Richard Schilling (St Bartholomew's Hospital, University of London, UK) and colleagues followed-up 285 patients with AF who underwent 530 wide-area circumferential catheter ablation procedures with confirmation of electrical isolation between 2002 and 2007. PeAF patients had linear lesions added with additional CFE targeting from 2005.
The patients were aged 56.5 years on average and 75% were male. In total, 151 patients had PAF and 134 had PeAF. The mean number of procedures per patient was 1.7 for PAF and 2.0 for PeAF.
After 2.7 years (0.2 to 7.4 years) of follow-up, 86% of PAF and and 68% of PeAF patients were free of AF and atrial tachyarrhythmia, and 95.1% of patients overall reported some degree of improved symptoms since pre-ablation. At final follow-up, 24.4% of all patients were still taking anti-arrhythmic drugs.
The team notes that use of CFE ablation for PeAF patients led to a nonsignificant trend for improved outcomes.
During the study period, there were no procedure-related deaths, seven nonprocedure or AF-related deaths, and three procedure-related strokes/transient ischemic attacks (0.6% cohort), while 1.7% of the patients had pericardial effusion requiring drainage as a result of the ablation.
The late AF recurrence rate was three per 100 years of follow-up after at least 3 years.
The researchers conclude in the journal Heart that catheter ablation is an effective treatment for the majority of AF patients, with CFE ablation may be a beneficial addition for PeAF.
They found that most AF recurrences occurred within 1 year and say this should be taken into account when assessing outcomes for future trials of ablative therapy for AF.
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By Helen Albert