Background: Percutaneous bilateral pulmonary vein isolation is recommended for symptomatic drug refractory atrial fibrillation (AF). Although having good short term results, long term efficacy and symptomatic improvement are not well established. Our goal was to evaluate the efficacy of pulmonary vein isolation and effect in quality of life on a large series of patients.
Methods: We studied 601 consecutive patients admitted to first AF ablation in our center, (56±11) years old, 72.9% male, 61.7% Hypertensive, 62.8% Paroxysmal AF, 30.4% Persistent AF, 6.8% Permanent AF) from 01-05-2005 to 31-11-2011. FUp was made by in clinic evaluation (with ECG or 24hours Holter by protocol and driven by symptoms) and by phone interview. Success was classified in: 1-free of AF (no symptomatic or documented AF); 2-Cinical AF (AF symptoms not documented by ECG or Holter and lasting more than 30 sec); 3-documented AF (lasting longer than 30sec); 4- Permanent AF. EHRA score was used to access quality of life before and after ablation.
Results: During a Fup of 1320±576 days, 43.8% of patients were free from symptomatic or documented AF; 45.1% with clinical AF; 36.9% with documented AF and 3% in permanent AF. The procedure was repeated in 20.7% of patients. The most powerful predictor of recurrence was left atrium volume accessed by angio TC (OR 2.23, 95%CI 1.18 – 4.25; p=0.015). Antiarrhythmic therapy was maintained in 40.3% of patients. A significant improve in EHRA score result was observed after ablation (average 2.7±0.6 before vs 1.27 ±0.6 after; wilcoxon p<0.001), even in patients with AF recurrence (2.7±0.5 before vs 1.4±0.7 after; p<0.001).
Conclusions: In our registry of patients submitted to pulmonary vein isolation, 36.9% of patients had documented recurrence during long term follow up. Although 56.2% of patients had symptomatic or documented recurrence, there was a significant improve in AF related symptoms and quality of life after ablation. Left atrial volume accessed by angio-TC was the main predictor of recurrence.