Background Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF... Show moreBackground Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry. Methods We described the real-life clinical epidemiology, therapeutic strategies, and the short- and mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (<2 years or >= 2 years). Results The mean AF history duration was 46.2 +/- 57.4 months, 592 patients had an AF history duration <2 years (mean 10.2 +/- 5.9 months), and 1356 patients >= 2 years (mean 75.5 +/- 63.5 months) (P < 0.001). Patients with AF history duration <2 years were younger; had a lower incidence of hypertension, coronary artery disease, and hypertrophic cardiomyopathy; and had a lower CHA(2)DS(2)-VaSc Score. At 1 year, the logrank test showed a lower incidence of AF recurrence in patients with AF history duration <2 years (28.9%) than in patients with AF history duration >= 2 years (34.0%) (P = 0.037). AF history duration >= 2 years, overall ablation procedure duration, hypertension, and chronic kidney disease were all predictors of recurrences after the blanking period. Conclusions In this multicenter registry, performing catheter ablation in patients with an AF history >= 2 years was associated with higher rates of AF recurrences at 1 year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified. Show less
The results of this thesis acknowledge one of the major contemporary problems in AF treatment, which is to find the optimal balance between ablation efficacy and related potential complications.... Show moreThe results of this thesis acknowledge one of the major contemporary problems in AF treatment, which is to find the optimal balance between ablation efficacy and related potential complications. A higher efficacy may be obtained by a more invasive ablation strategy, while this type of procedure also seems to increase the risk for complications. On the other hand, simplifying the procedure with a so-called single-shot device can also lead to an increased complication rate. Therefore, optimization of procedures with currently available catheters may be the best strategy to achieve a highly effective procedure for patients with paroxysmal or even persistent AF, without leading to significant complications. A minimally invasive strategy may be suitable for patients with (longstanding) persistent AF, especially if these patients have no comorbidities that require open heart surgery. The studies described in this thesis contributed to further elucidating the feasibility and potential risks of performing new ablation procedures and catheters. This may contribute to optimize AF ablation procedures. Show less
