Abstract 2100: Curative Ablation for Atrial Fibrillation: Is There a Late Attrition Rate?
Background Large population of pts who undergo pulmonary vein isolation (PVI) for atrial fibrillation (AF) have a complete response (CR), become AF-free (AFF) and require no antiarrhythmic drug (AAD) therapy. It is unclear if despite a prolonged AFF period after ablation (ABL), there is genuine cure or if there is an important attrition rate. We sought to quantify and characterize the “initial responders (R)” who experience a prolonged AFF CR and develop late recurrence (LR).
Methods/Results A consecutive series of 223 pts (males 72%, age 56 ± 12 yrs, paroxysmal AF 82%) with ≥ 1 yr AFF f/u after complete PVI on no AADs were identified and followed for 1–5 yrs. Symptomatic recurrence was seen in 18 pts at 809 ± 349 days post ABL. The survival plot indicates progressive attrition rate beginning ~2 yrs post ABL that increases to 25% at 5 yrs. Compared to long-term R, LR pts were similar in age, structural heart disease, lone AF, pattern of AF, LA dimensions, and LV function. 14/18 pts showed rapid progression to recurrent AF requiring repeat ABL procedure. In 13/14 (93%) pts, ≥ 1 PV required reisolation; 19/34 (56%) PVs showed reconnection. All PVs were reisolated and 4 pts had additional linear ABL.
Conclusion An important recurrence rate of AF appears late after successful ABL despite > 1 yr freedom from AF, although majority remain AFF. LR pts had no unique clinical characteristics (i.e. indicative of extensive substrate). Most LR were associated with PV reconnections, similar to early recurring pts, but the mechanism of late AF remains uncertain. These observations stress importance of continued long-term f/u and raise questions regarding need for chronic anticoagulation despite apparent response.