Long-term Follow-up After Right Atrial Radiofrequency Catheter Treatment of Paroxysmal Atrial Fibrillation

Unlabelled: Catheter ablation of paroxysmal atrial fibrillation using long linear lesions in the right atrium is still under investigation, and its long-term follow-up is unknown.

Methods: Thirty-six men and nine women (aged 51 +/- 12 years) with symptomatic daily episodes of AF for 6 +/- 5 years despite the use of 4.7 +/- 1.5 antiarrhythmic drugs were studied between July 1994 and January 1996. Progressively longer ablation lines were performed in 3 groups of 15 consecutive patients each, using a 14-electrode catheter or a single-electrode dragging technique. Success was defined as atrial fibrillation elimination or recurrence for no longer than 6 hours over 3 months of observation. Patients who had fewer than 6 hours of atrial fibrillation per month were considered "improved." Medium- (11 +/- 4 months) and long-term (26 +/- 5 months) results were assessed clinically from a patient's diary and from Holter recordings.

Results: After a follow-up of 11 months, 24 patients had a favorable result of the ablation procedure with or without additional antiarrhythmic drug therapy, representing 53% of the original cohort. After 26 +/- 5 months of follow-up, these successful results were reduced to 17 patients (37%).

Conclusions: After linear atrial ablation, a significant long-term attrition of arrhythmia-free patients was observed. This may be due to a combination of disease progression, incomplete linear block, and ineffective ablation of arrhythmogenic triggers.