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Long-term clinical outcome of patients who failed catheter ablation of atrial fibrillation.

AIMS
Left atrial ablation fails to prevent symptomatic recurrences of atrial fibrillation (AF) in 20-30% of patients up to 3 years of follow-up despite multiple procedures. Data are lacking on the long-term clinical outcome of those patients for whom the decision was taken to renounce performing further ablation procedures.


METHODS AND RESULTS
In this multicentre study, 218 (34%) of 631 consecutive patients, who had undergone AF catheter ablation in the years 2001-11 for drug-refractory symptomatic AF, had symptomatic AF recurrences after 1.5 ± 0.6 procedures. Their long-term clinical outcome was assessed in March 2012 (minimum follow-up 1 year). At a mean of 5.1 ± 2.6 years since their last ablation, 82 (38%) patients improved, 103 (47%) remained unchanged and 33 (15%) worsened, but only 17 (8%) had such a severe impairment of their quality of life as to require atrioventricular junction ablation and pacing (#13) or cardiac surgery (#4); 22 (10%) patients had had adverse clinical events (death in five, heart failure in five, stroke and transient ischaemic cerebral attack in four, severe haemorrhage in four, pacemaker or implantable cardioverter-defibrillator implantation in seven) and 98 (45%) patients had developed permanent AF. Compared with patients without permanent AF, fewer patients with permanent AF improved (3% vs. 66%, P = 0.001) and more got worse (28% vs. 5%, P = 0.001). At multivariable logistic regression, single ablation procedure, left atrial diameter, persistent AF and time from the last ablation were independent predictors of permanent AF.


CONCLUSION
More than 5 years after a failed AF ablation, a small minority of patients had such an impaired quality of life as to require non-pharmacological interventions. Almost half developed permanent AF, which significantly impaired quality of life. Permanent AF was more common in patients who had left atrial enlargement, history of persistent AF, longer follow-up, and had performed a single ablation procedure, thus hypothesizing that reablation could reduce the chronicization of arrhythmia. A low risk of stroke was observed in the long-term follow-up.