Significance of late recurrence of atrial fibrillation during long-term follow-up after pulmonary vein isolation

Background and Study Objective: Patients with paroxysmal or persistent atria] fibrillation (AF) can be treated by pulmonary vein (PV) isolation. Although the recurrence rate after the procedure is relatively high, the long-term outcomes after initially recurrence free procedures remains unclear. We examined the rates of recurrence of AF after PV isolation. Methods: Our study included 278 consecutive patients with drug-refractory AF (mean age = 53 +/- 11 years, 228 men). PV isolation was based on the disappearance of PV potentials recorded from a circumferential catheter after segmental ostium ablation. Cavo-tricuspid isthmus lines and additional atria] lines were performed in 124 and 28 patients, respectively. Patients were monitored for a mean of 26 11 months (range 12-56). Recurrence was defined as >= 1 episodes of symptomatic or asymptomatic AF > 1 month after the procedure. Results: A total of 120 (34) patients had >= 1 recurrence of AF >1 month after the procedure, of whom 14 (4) had a first recurrence >6 months after the procedure. There was a significantly higher recurrence rate among patients with persistent AF. Conclusions: A relatively high AF recurrence rate was observed after PV isolation. AF may recur late after the ablation procedure, though the majority of recurrences occurred within 6 months after the first procedure. There were no differences in incidence or time of occurrence of late recurrences between patients with paroxysmal versus persistent AF.