Arrhythmia-free survival rates after a single catheter ablation procedure for atrial fibrillation (AF) were 40% after a year but dropped to below 30% after five years' follow-up, a study from France has found.The study followed 100 patients (86 men), age 55.7±9.6 years with drug refractory AF, who were treated with catheter ablation between January 2001 and April 2002. The analysis included patients with symptomatic disease and/or AF complicated by stroke, transient ischaemic attack, or heart failure. Nearly two thirds (63%) of patients had paroxysmal AF while 22% had persistent AF. Following a single ablation procedure arrhythmia-free survival rates were 40%, 37%, and 29% at one, two, and five years respectively. Most recurrences were during the first six months.In total 175 ablations were performed on 100 patients with a median of two procedures per patient. If the recurrence rate since the last ablation was considered the arrhythmia-free survival rate increased, with rates of 87%, 81%, and 63% at one, two, and five years respectively.The only predictor of recurrence in a univariate analysis was the type of AF. Patients with longer standing AF were nearly twice as likely to have a recurrence compared with those with paroxysmal or a shorter duration of AF; hazard ratio (HR) 1.9 (95% CI: 1.0-3.5, p=0.0462). The presence of valvular heart disease, HR 6.0 (95% CI: 2.0-17.6, p=0.0012) and nonischaemic dilated cardiomyopathy, HR 34.0 (95% CI: 6.3-182.1, p<0.0001) were independent predictors of recurrent AF in multivariate analysis.Newer techniques including the use of irrigated catheters and circumferential pulmonary vein isolation are likely to improve the long-term outcomes still further. However, it is clear that catheter ablation should be seen as a treatment option for AF rather than a cure and patients should be aware of this in the decision making process.Furthermore, ongoing surveillance is important after successful ablation and the CHADS2 score should continue to be applied to inform anticoagulation strategies rather than basing this on the initial success of ablation. Finally, it should be remembered that this study did not consider AF burden and if a patient were suffering daily symptoms from AF then even the odd recurrence post ablation would probably be deemed a success from their point of view. 

Dr Peter Savill