Ten-year Follow-up Study of Patients with Persistent Atrial Fibrillation Treated by Combined Pulmonary Vein Isolation and Complex Fractionated Electrogram Ablation.

Aim: This study retrospectively investigated the clinical outcomes of patients with persistent AF treated with a combined approach of pulmonary vein isolation (PVI) and complex fractionated atrial electrogram (CFAE) ablation over a follow-up period of 10 years. Methods: A total of 73 patients with persistent and long-standing persistent AF who underwent combined pulmonary vein isolation and CFAE ablation in the first procedure were included. A complete CFAE mapping of the left atrium and coronary sinus was performed with a 3D mapping system. All CFAEs defined as electrograms with continuous activity or mean cycle length detected by the system of <80 ms were excluded. Patients were controlled regularly during the first year followed by annual control. Any documented atrial tachyarrhythmia (ATA) was regarded as a recurrence. Results: After index ablation, 18 (24.7%) were free of ATAs during 10-year follow-up. The proportion of atrial flutter (AFL) was 39.7%, with six typical AFL. A mean of 2.2 ± 1.2 ablation procedures were performed in each patient. After multiple procedures, 33 (45.2%) patients were free of ATA during the follow-up. The proportion of AFL was 23.2% with no typical AFL. Older age, female sex and a longer AF history were associated with ATA recurrence. Conclusion: A high recurrence rate of ATA was observed after index procedure of pulmonary vein isolation plus CFAE ablation in patients with persistent AF. No significant difference in freedom of ATA was found between persistent and long-standing persistent AF groups beyond 1 year. The incidence of postablation AFL was particularly high, even after multiple ablations.