Long-term outcome of right and left atrial radiofrequency ablation in patients with persistent atrial fibrillation

OBJECTIVES: To investigate the clinical outcome of right and left atrial radiofrequency ablation after the first 12 months in patients with drug-refractory persistent atrial fibrillation (AF), and to identify predictors of long-term success. METHODS: We analyzed the clinical outcome of 74 consecutive patients with a follow-up >12 months who underwent right and left atrial ablation for persistent AF. Patients who did not present symptomatic or asymptomatic atrial tachyarrhythmias (AT) lasting >30 seconds after the first 3 months of follow-up were defined responders to pulmonary veins ablation. RESULTS: After a mean follow-up of 20.2 +/- 6.3 months (12-36), 52/74 (70%) patients were deemed responders. AT relapsed within the first 12 months in 19/74 (26%) patients (17 AF and 2 left atrial flutter). Among those patients who did not relapse within the first 12 months, only 3 patients (5%) presented AF after the first year of follow-up. At the multivariate analysis presence of early AT relapse and history of AF >7 years inversely correlated with a successful long-term clinical outcome. CONCLUSION: Right and left atrial ablation, alone or in association with antiarrhythmic drugs, prevented AT relapses in 70% of patients with drug-refractory persistent AF also after the first 12 months. Presence of AT relapse within the first 3 months and history of AF >7 years identified patients with a lower probability of successful long-term clinical outcome.