Long‐Term Outcomes After Catheter Ablation: A 42‐Month Longitudinal Study From the ITHACA‐Database

BACKGROUND: There is a paucity of real-world data on the long-term clinical outcomes of patients undergoing catheter ablation (CA) for atrial fibrillation (AF). OBJECTIVE: Assess long-term outcomes for patients undergoing CA for AF in a large multicenter health system. METHODS: We analyzed consecutive patients undergoing de novo CA for AF at one of Northwell Health's five electrophysiology laboratories between 2015 and 2021 from the ITHACA-Database. The primary composite outcome (freedom from AF) was defined as the absence of electrocardiographically documented AF > 30 s, direct current cardioversion (DCCV), ongoing therapy with a Class I/III AAD 3 months after index CA, or repeat ablation any time post-index CA throughout extended longitudinal follow-up (97% patient retention). Regression was performed to identify predictors. The annual risk of recurrence was also calculated. RESULTS: Three thousand four hundred forty patients (69.4 ± 10.2 years, 44% females, 64% paroxysmal AF) were observed for an average time of 42 ± 9.2 months. The primary composite outcome was achieved in 65% at 1 year, 59% at 2 years, and 52% at the last follow-up (42 months). While the 1-year composite outcome of freedom from AF post-ablation was higher for patients with paroxysmal AF compared to persistent AF (69% vs. 61%), the annual risk for recurrence for every year thereafter was similar (+6% vs. +7%). Patients who remained AF-free at 1-year post-index ablation had higher chances of freedom from AF at 42 months (80% vs. 48%, p = 0.001). The annual risk of recurrence for patients who were AF-free the first year was 5%, significantly less than those who experienced AF recurrence within the first year (12%, p = 0.002). CONCLUSION: Annual recurrence rates appear similar across AF types after the first year post-ablation. Maintaining sinus rhythm for 1 year after the initial ablation significantly increases the likelihood of long-term freedom from AF.