AIMS: Data on long-term follow-up of patients who have undergone catheter ablation for atrial fibrillation (AF) are very limited. This report aimed at presenting clinical outcome and AF-free survival after pulmonary vein (PV) isolation over an extended (>3 years) follow-up period. METHODS AND RESULTS: Thirty-nine patients subjected to PV isolation for paroxysmal AF were followed-up for at least 3 years according to a strict protocol. Fourteen patients (35.8%) had one, 19 patients (50%) had two, and 6 patients (15.4%) had three ablation procedures. At end of follow-up (42.2 +/- 6.0 months), 17 patients (43.5%) were completely free of AF or other atrial arrhythmia, and 26 patients (66.6%) had symptomatic improvement. The long-term success rate was 21.4% for patients subjected to a single ablation procedure, 52.6% for patients subjected to two catheter ablation procedures, and 66.7% for patients who underwent three ablation procedures (P = 0.094). There was also a trend for patients who underwent a combination of different ablation procedures (ostial, antral, and/or circumferential) to have a higher AF-free survival when compared with patients subjected to the same procedure (P-value for log-rank test = 0.036). CONCLUSION: Catheter ablation does not eliminate paroxysmal AF in up to 56% of patients in the long term, despite the use of two or three ablation procedures in two-thirds of them. However, it confers symptomatic improvement in 67% of treated patients.