Long-term outcomes of adjunctive complex fractionated electrogram ablation to pulmonary vein isolation as treatment for non-paroxysmal atrial fibrillation.

PURPOSE: The adjunctive ablation of areas of complex fractionated electrogram (CFE) to pulmonary vein isolation (PVI) is an emerging strategy for patients with non-paroxysmal atrial fibrillation (AF). We studied the long-term outcomes of this approach.
METHODS: Sixty-six patients (mean age 58 ± 9, 86.4 % male) with non-paroxysmal AF underwent ablation procedures consisting of PVI plus extensive CFE ablation. Post-ablation atrial tachycardia (AT) was also targeted if presented. All patients were followed up regularly on an ambulatory basis by means of ECG and Holter recordings.
RESULTS: After a mean follow-up period of 40 ± 14 months and 1.7 ± 0.7 procedures, 38 patients (57.6 %) were free of arrhythmias, 15 (22.7 %) displayed clinical improvement and 13 (19.7 %) suffered recurrences of persistent AF/AT. Females displayed poorer long-term outcomes than males (arrhythmia-free 22.2 vs. 63.2 %, p < 0.05). Multivariate analysis demonstrated that long duration of uninterrupted AF prior to the procedure was an additional predictor of long-term failure (odds ratio 1.49, p < 0.01). ROC analysis (area under curve 0.80; p < 0.001) estimated 3.5 years as the optimal cut-off point for predicting long-term failure (sensitivity 85 %, specificity 74 %). The cumulative data showed a significantly higher percentage of arrhythmia-free patients when the duration of AF had been ≤ 2 years (69.7 %) and ≤ 4 years (68.9 %) than when it was > 4 years (33.3 %; p < 0.01).
CONCLUSIONS: PVI + CFE ablation in non-paroxysmal AF appears to provide a reasonable proportion of arrhythmia-free patients during long-term follow-up. Poorer long-term results can be expected among female patients and those with an uninterrupted AF duration of > 4 years.