20 Years: Clinical Outcome After Pulmonary Vein Isolation in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation.

BACKGROUND

Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for paroxysmal atrial fibrillation (PAF), but outcome data beyond 10 years are limited.

OBJECTIVES

This study sought to evaluate 20-year outcomes of PVI for PAF.

METHODS

From 2003 to 2004, patients with symptomatic, drug-refractory PAF underwent PVI with radiofrequency current, confirmed by the double-lasso technique. Freedom from atrial fibrillation/atrial tachycardias (ATs) after multiple procedures was assessed in all patients. Very late AT recurrences were defined as recurrence >10 years after last ablation. Long-term cardiovascular outcomes were analyzed over 2 decades.

RESULTS

A total of 154 patients (median age 76 years [Q1-Q3: 66-83 years], 26% female) were included with a median follow-up duration of 19.3 years (Q1-Q3: 15.9 years to not available). Multiple procedural success was 25% after 20 years and a mean of 2 ± 1 ablation procedures, with 24% of patients on antiarrhythmic drugs. The progression rate from PAF to persistent atrial fibrillation was 13% (n = 20 of 154). Very late AT recurrences were associated with high PVI durability of 83%. Long-term outcomes included 7 (4.5%) thromboembolic events, 3 (1.9%) cardiopulmonary resuscitations, 3 (1.9%) acute coronary syndromes and 1 (0.6%) major bleeding, and 19 (12%) deaths (42% cancer, 26% unknown, 16% cardiovascular). Oral anticoagulation was discontinued in 48% (n = 75 of 154) of patients, with 73% (n = 55 of 75) of these patients in stable sinus rhythm at the last follow-up.

CONCLUSIONS

During 20 years post-PVI, 25% of patients maintained stable sinus rhythm, including multiple ablation procedures and antiarrhythmic drugs. Despite being at risk for stroke, half of the patients were off anticoagulation, with the majority being "PVI responders" in stable sinus rhythm. The low stroke rate during long-term follow-up may indicate a potential beneficial effect of PVI; however, confirmation in larger studies is necessary.