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Ablation of paroxysmal atrial fibrillation: real impact over the long term?

Atrial Fibrillation


Douglas Packer presented the current data on the impact of ablating PAF on morbidity and mortality. So far, no large randomised trials have been completed shedding light on these questions. Data from observational studies indicate that cardiovascular events and mortality are lower in patients ablated for AF than in patients with AF not undergoing ablation. In experienced hands, ablation procedures bear a low, but not negligible risk for serious complications. We have to await the results of the ongoing large randomised trials, CABANA and EAST to learn the effects of ablation for AF on hard endpoints such as mortality and stroke.

Dr. Sommer presented data on the effects on stroke and cognitive dysfunction. The risk of a periprocedural stroke with PAF ablation is lower than 0.5%. Observational registry data and cohort studies indicate that ablation for PAF may reduce long term stroke rate to levels similar to what is observed in patients without AF.

Observational data even indicate that dementia may be reduced in patients ablated for AF as compared with those not undergoing ablation. However, caution needs to be taken in interpreting these data, coming from non-randomised cohort studies, potentially flawed by selection bias as well as bias introduced by the post-procedural management of patients who underwent ablation (meticulous follow-up including appropriate anticoagulation, treatment of hypertension and any structural heart disease).
Dr Duytschaever presented our current knowledge on maintenance of sinus rhythm after ablation for PAF. Five-year freedom from recurrent AF is around 50% after a single ablation procedure and 80% after repeated ablation procedures required in approximately half the patients. In responders without recurrent AF one year after the ablation procedure, the rate of recurrent AF is approximately 25% over 4 years, and related to recurrent conduction of the electrical impulse from the pulmonary veins, as well as substrate progression.

In the last talk, Dr Crijns discussed progression of AF from self-terminating forms towards persistent and permanent AF. AF is a progressive disease, and the risk factors predicting progression of AF towards persistent and permanent forms are similar to those for stroke. There are observational data supporting the hypothesis that rhythm control with antiarrhythmic drugs or ablation may reduce progression of AF.

References


Session Title: Ablation of paroxysmal atrial fibrillation: real impact over the long term?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.