• Masateru Takigawa, Atsushi Takahashi, Taishi Kuwahara, Kenji Okubo, Yoshihide Takahashi, Yuji Watari, Katsumasa Takagi, Tadashi Fujino, Shigeki Kimura, Hiroyuki Hikita, Makoto Tomita, Kenzo Hirao, and Mitsuaki Isobe.
• Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
• Circ Arrhythm Electrophysiol. 2014 Apr 1; 7 (2): 267-73.

BackgroundAlthough catheter ablation (CA) is a standard treatment for atrial fibrillation (AF), its long-term efficacy remains unclear. This study aimed to elucidate the incidences of AF recurrence and of progression from paroxysmal to persistent AF, after CA, in patients with paroxysmal AF.Methods And ResultsWe examined the incidence of AF recurrence and AF progression in 1220 consecutive patients (mean age, 61 years), with symptomatic paroxysmal AF, undergoing CA, based on extensive pulmonary vein isolation and focal ablation for nonpulmonary vein foci. AF recurrence-free survival probabilities at 5 years were 59.4% after the initial CA and 81.1% after the final CA (average, 1.3 procedures). During a median follow-up period of 47.9 (range, 5.3-123.3) months after the initial CA, AF progressed from paroxysmal to persistent in 15 (1.2%) patients (0.3%/y). The duration of AF history (hazard ratio [HR], 1.03; P<0.0001), number of ineffective antiarrhythmics (HR, 1.09; P=0.005), and left atrial diameter indexed by the body surface area (HR, 1.05; P=0.001) were significant predictors of AF recurrence. Patient age (HR, 1.12; P=0.0001) and left atrial diameter indexed by the body surface area (HR, 1.26; P=0.0006) were significantly associated with AF progression. Patients aged≤65 years and with a left atrial diameter indexed by the body surface area of ≤24.0 mm/m2 did not develop AF progression for ≤10 years after the initial CA.ConclusionsAlthough the long-term follow-up revealed the effect of CA on preventing AF recurrence, repeated CA sessions might be required. The rate of progression from paroxysmal to persistent AF was 0.3%/y.

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