Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients.

AIMS: Identifying suitable candidates for circumferential left atrial pulmonary vein ablation (CPVA). CPVA is widely used as an ablation strategy in patients with atrial fibrillation (AF). Understanding the predictors of long-term success of single catheter ablation procedure of AF based on CPVA can help to identify those patients who have a high risk of recurrence based on this approach.

METHODS AND RESULTS: In this retrospective analysis 674 consecutive patients (464 male, mean age 57.3 +/- 10.8 years) with AF (84.8%, paroxysmal) treated with CPVA ablation between May 2005 and August 2007 using a manually controlled steerable sheath (Agilis((R)) St. Jude Medical Inc., St. Paul, MN, USA), were included. The endpoint of the ablation was the completion of predefined lesions (CPVA for paroxysmal, and CPVA+mitral isthmus and roof line ablation for persistent AF). Seven day Holter recordings were done immediately, 3, 6, and 12 month after ablation. AF longer than 30 s was considered as recurrence. The success was defined as lack of recurrence during 7-day Holter recordings done 3, 6, and 12 months after ablation. Early recurrence was defined as recurrence during the first 7-day Holter recording immediately after ablation. Forty-five and 20.8% of the patients received antiarrhythmic medications for the first 3 and 6 months after ablation procedure, respectively. After 6 months all antiarrhythmics were discontinued. About 51.5% experienced early recurrence. Twelve months success rate was 75.7% (paroxysmal: 75.7%, persistent: 75.0%, P = 1.0). Using multivariate analysis left atrial (LA) diameter > or =50 mm was the predictor of early recurrence {Hazard Ratio (HR) [95% confidence interval (CI)] = 5.1 (2.0-12.9)}. LA Diameter > or =50 mm [HR (95% CI) = 4.6 (2.6-9.1)]; early recurrence [HR (95% CI) = 4.3 (2.0-9.1)]; and arterial hypertension [HR (95% CI) = 4.6 (2.6-9.1)] were predictors of late recurrence.

CONCLUSION: In our patients' cohort, a single catheter ablation procedure based on CPVA using steerable sheath for catheter navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.