Welcome to our 7th ablation/maze survey. Previous surveys dealt mainly with the immediate success of catheter ablations or surgical procedures. This 2011 survey and the previous 2009 survey, however, focus on the long-term success. Long-term success in the case of catheter ablations for lone AF is a relative term since these procedures did not become common until about 10 years ago.
A total of 55 respondents who had undergone their final procedure prior to November 2005 participated in the 2011 survey. The majority of procedures reported (96%) were radiofrequency catheter ablations. Of the 52 respondents undergoing RF ablation, 33 (63%) underwent a single procedure, while 19 (37%) underwent 2 or more procedures for the purpose of curing AF. The most widely used and most successful procedure for paroxysmal AF was the pulmonary vein antrum isolation procedure developed by Dr. Andrea Natale closely followed by the segmental pulmonary vein isolation procedure (Haissaguerre protocol), which was especially successful among permanent afibbers.
The most important variable determining long-term success was whether or not a respondent had an initially successful procedure, i.e. they remained in sinus rhythm without the use of antiarrhythmics during the last 6 months of the 12-month period following their final procedure (index period). The long-term prognosis for an afib-free future without the use of antiarrhythmic drugs after an initially successful catheter ablation is excellent with 73% of paroxysmal afibbers and 67% of permanent afibbers being in this enviable state 6 years following their final procedure. In comparison, in the initially unsuccessful group only 40% of paroxysmal afibbers and 0% of permanent afibbers achieved this status.
The criterion for complete success in year 6 following the final ablation was zero afib episodes during the year without the use of antiarrhythmics. In reality, most afibbers would be quite happy living with 1 or 2 short-lived episodes a year. Looking at it this way, 3 more ablations could be considered successful (99% reduction in afib burden) in the group of 30 paroxysmal afibbers who underwent an initially successful ablation. Thus, the complete success rate for year 6 increases from 73% to 83% for this group. Similarly, the complete success rate would increase from 40% to 60% in the group of paroxysmal afibbers who had an initially unsuccessful ablation. In addition, 3 out of 4 permanent afibbers reverted to paroxysmal afib with an average 6-month burden of 45 hours, or a 99% improvement.
There is also encouraging news for those afibbers whose final procedure was not successful. At the end of year 6, 9 paroxysmal afibbers were still experiencing afib episodes. However, their frequency was down by 92% from pre-procedure levels and the total time spent in afib was down from 4% to 0.07%. The reduction in afib burden from pre-procedure days to year 6 was 98% and this decline was pretty well universal with only 1 respondent reporting an increase in burden. Thus, even if an ablation is not completely successful, it is extremely likely to materially reduce afib burden and improve quality of life. This also applies to permanent afibbers who saw an average decline in the time they spent in afib from 100% to 0.2% even if their procedure was not completely successful.
Wishing you and yours a joyous Holiday Season with good health and lots of NSR in the New Year,Hans