Aims: Clinical benefit from ablation for long-standing persistent atrial fibrillation has remained unknown. We hypothesized that successful ablation of long-standing persistent atrial fibrillation would improve haemodynamics, functional status, and quality of life.
Methods and results: A total of 160 patients (aged 59 ± 9 years, 23% females) undergoing ablation of long-standing (median of 28 months) persistent atrial were enrolled in this prospective study. Morphological and functional echocardiographic parameters, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), maximum oxygen consumption during exercise test (VO2 max), and quality of life were assessed at baseline and 1 year after the ablation. At the 1-year follow-up visit, 81% patients were examined in sinus rhythm (after repeat ablation in 38% patients). Left atrial appendage outflow velocity increased from 44 ± 20 to 58 ± 23 cm/s, left ventricular ejection fraction from 54 ± 9 to 59 ± 5%, and VO2 max from 20.4 ± 6.4 to 23.7 ± 8.1 mL/kg/min; NT-proBNP decreased from median 897 (interquartile range 603-1424) to 230 (interquartile range 120-420) pg/mL (all P < 0.0001). These beneficial effects of ablation were predominantly associated with the presence of sinus rhythm. Quality of life (range 0-100) increased significantly (EQ-5D index: from 68.8 ± 12.5 to 75.4 ± 14.4; EQ-VAS score: from 62.8 ± 13.2 to 70.6 ± 13.8; both P < 0.0001).
Conclusion: Ablation of long-standing persistent atrial fibrillation was associated with significant recovery of haemodynamics and exercise capacity that projected onto the long-term improvement in quality of life.
Keywords: Atrial fibrillation; Catheter ablation; Long-standing persistent; Outcome.