Most studies evaluating the efficacy of atrial fibrillation (AF) ablation report follow-up periods of 1 year to 2 years, but few report long-term results of > or =5 years after ablation. Therefore, we evaluated the long-term efficacy (i.e., >5 years) of segmental antrum pulmonary vein isolation (PVI) for paroxysmal AF. Seventy-one patients (60 +/- 10 years, 56 men) who underwent PVI for paroxysmal AF from January 1, 2002, to August 31, 2003, were followed for at least 5 years after their index ablation procedure. Five-year outcomes were determined at last clinic visit, by telephone encounters, and by cardiac monitoring when available. After 1 ablation, off antiarrhythmic drugs, 61 patients (86%) were free of symptomatic AF at 12 months, 56 patients (79%) at 24 months, and 40 patients (56%) at 63 +/- 5 months. Sixteen patients (22.5%) had AF recur after the second year after ablation. Thirty-one patients underwent > or =1 repeat ablations (1.6 +/- 0.9 per patient). After multiple procedures, 58 patients (81%) were free of symptomatic AF off antiarrhythmic drugs at 63 +/- 5 months after their initial ablation; however, in 18 of these patients who received multiple ablation procedures, mean duration of follow-up after the last ablation was only 13.5 +/- 2.1 months. In conclusion, overall 5-year outcome after PVI for paroxysmal AF is similar to that previously reported for shorter-term follow-up (< or =2 years). However, late recurrences >2 years after initial ablation were frequent, and repeat ablation was often required to maintain freedom from symptomatic AF.