Very Long-term Outcomes of PAF/CAF Ablation

Ablative Intervention for atrialfibrillation may be highly successful in decreasing the frequency of episodes and improving quality of life. Nevertheless the majority of studies used to support ablative therapy track outcomes for no more than one year. In six clinical trials, success rates as high as 70-80% have been reported. In the STOP AF trial, 69.9% of patients were AF free following cryo balloon ablation compared with 7.3% of patients commonly treated with antiarrhythmic drug therapy. In other clinical trials, the success rate for drug therapy has been in the 10-30% range. The Second International Ablation Registry has suggested longer-term success rates of 75% for patients with paroxysmal atrial fibrillation and 65% in those with more long-standing persistent atrial fibrillation. More recently, several groups have reported their long-term results, chronicling outcomes over the course of 3-5 years. Wokhlu, et al, reported the 3-year outcomes in patients undergoing ablative intervention. This was closer to 60-65% in those with paroxysmal atrial fibrillation and 55-65% in those with long standing persistent atrial fibrillation. Predictors of recurrence included the use of WACA ablation, along with the presence of significant underlying disease, long standing persistent atrial fibrillation, and factors such as hypertension and diabetes, suggesting a substrate mediated potential for recurrence. Others including Feld, Steinberg, Haissaguerre, and Kuck have identified similar outcomes. As such, the long-term success rates may be appreciably different than those indicated on web sites and in observational studies. Another limitation of these data is that they chronicle short-term efficacy, without looking at long-term efficacy and safety outcomes. In the CABANA Trial, 3000 patients will be enrolled and followed for 3-5 years to establish the utility of ablation in decreasing mortality related to atrial fibrillation. In addition, long-term stroke, pulmonary vein stenosis, and neurologic outcomes will be tracked. This study is well under way, having already enrolled 400 patients, with plans to complete enrollment within 2 additional years. This international study will be critically important to give the very best sense of long-term outcomes of ablation. This presentation in Japan will chronicle available data and look into the future as to the anticipated outcomes of this nonpharmacologic approach.