A long-term follow-up study published in the Arrhythmia & Electrophysiology Review has revealed that combining pulmonary vein isolation (PVI) with complex fractionated atrial electrogram (CFAE) ablation in patients with persistent atrial fibrillation (AF) results in modest, long-term success, with nearly 55% of patients experiencing arrhythmia recurrence despite multiple ablation procedures.
The retrospective study followed 73 patients with either persistent or long-standing persistent atrial fibrillation (AF) for 10 years. All patients received a combined PVI + CFAE ablation during their initial procedure, utilizing advanced 3D electroanatomical mapping to target atrial regions exhibiting abnormal electrical activity.
After the first (index) ablation, only 24.7% of patients remained free from atrial tachyarrhythmias (ATAs) at 10 years. Multiple ablation procedures improved the outcome, with 45.2% achieving long-term freedom from atrial tachyarrhythmias (ATAs). Atrial flutter (AFL) emerged as a frequent post-ablation complication, occurring in nearly 40% of patients after the first procedure and 23.2% after subsequent ablations; however, the typical flutter forms were eliminated after repeated procedures.
Older age, female sex, and longer history of AF were predictors of ATA recurrence. The study found no significant difference in long-term outcomes between patients with persistent and long-standing persistent atrial fibrillation (AF).
• Seventy-three patients with persistent or long-standing persistent atrial fibrillation (AF) were followed for 10 years.
• The initial success rate of achieving freedom from arrhythmia was only 24.7% after a single procedure.
• 45.2% achieved arrhythmia-free status after an average of 2.2 ablations.
• Atrial flutter was common after the index procedure (39.7%) and reduced to 23.2% after further ablations.
• Predictors of recurrence: older age, female gender, and longer AF duration.
• No significant difference in outcome between persistent and long-standing persistent AF.
• Findings highlight the complexity of managing persistent atrial fibrillation (AF) and underscore the need for individualized, long-term strategies.
Wollner K, Tønseth C, Solheim E, Chen J. Ten-year Follow-up Study of Patients with Persistent Atrial Fibrillation Treated by Combined Pulmonary Vein Isolation and Complex Fractionated Electrogram Ablation. Arrhythm Electrophysiol Rev. 2025;14:e07. Published 2025 Feb 28. doi:10.15420/aer.2024.43
Combining pulmonary vein isolation (PVI) with complex fractionated atrial electrogram (CFAE) ablation in patients with persistent atrial fibrillation (AF) yields modest long-term success, with nearly 55% of patients experiencing arrhythmia recurrence despite undergoing multiple ablation procedures.