Long-term results of atrial fibrillation ablation: the importance of all initial ablation failures undergoing a repeat ablation.

BACKGROUND: Ablation is more successful for patients with paroxysmal atrial fibrillation (AF1) than for those with persistent (AF2) or longstanding persistent AF (AF3). Many patients fail initial ablation and undergo repeat ablations. Little is known about repeat ablation procedure times, complications, and outcomes.

METHODS: We evaluated Kaplan-Meier freedom from AF by AF type and sex for initial and repeat ablations and for final status of 843 patients undergoing 1122 ablations. We examined complications, procedure times and reasons why patients do not undergo repeat ablations. Cox multivariate analysis evaluated factors predicting ablation failure.

RESULTS: Initial ablations were more successful in AF1 than AF2 or AF3 (P < .0001) patients. For each AF type, repeat ablations were more successful than initial ablations (P = .01 to <.001). Procedure times (139.1 ± 49.1 vs 135.3 ± 45.6 minutes, P = .248) and major complications (1.66% vs 2.87%, P = .216) were similar. Women had different clinical characteristics than men, similar initial and repeat ablation success rates but lower overall success because of fewer repeat ablations (57.8% vs 68.2%, P = .047) due to patient choice (P = .028). Patients with either successful initial ablations or undergoing repeat ablations had late AF recurrence rates of 0% to 1.5% a year. Age (P = .012), larger left atria (P = .002), female sex (P = .001), AF2 (P < .0001), AF3 (P = .003), and coronary disease (P = .003) predicted failure.

CONCLUSIONS: Repeat ablations are more successful than initial ablations, have similar procedure times and complication rates, help determine final success rates, and may explain sex difference in success rates. For the best outcomes, patients should assume that a repeat ablation may be required to eliminate AF.