Ablation - long-term results from a large cohort of patients

[journals.lww.com]


Ablation of paroxysmal and persistent atrial fibrillation with multielectrode phased radiofrequency duty-cycled catheters: long-term results from a large cohort of patients

Nardi, Stefano; Argenziano, Luigi; Cappato, Riccardo; de Martino, Giuseppe; Esposito, Cristina; Scaglione, Mariano; Borrello, Francesco; Maglia, Giampiero


Background: Catheter ablation is a widely used approach to treat patients with drug refractory paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (CAF). The aim of this analysis was to evaluate the long-term safety and efficacy of the multielectrode/phased radiofrequency (RF)/duty-cycled ablation catheters in the treatment of both PAF and CAF in a large cohort of patients.

Methods and results: From July 2008 to February 2010, 429 consecutive drug refractory symptomatic patients (mean age 60+/-12 years old, 58% men, 68% PAF, 32% CAF) were treated. Seventy-five patients had two procedures resulting in a total of 504 procedures (procedure mean time: 62 +/- 15 min). Following ablation, 4-day continuous Holter monitoring was done every 3 months. Recurrence was defined as any atrial tachyarrhythmia of more than 30 s. At 3 months 97.4% of patients were off antiarrhythmic drugs. During a mean follow-up of 22 +/- 5 months, freedom from AF recurrence was 68.5% (95% CI: 63.8-72.6) and higher for PAF than CAF patients. The risk of AF recurrence in PAF patients increased in the presence of hypertension, dyslipidemia, large left atrial diameter (LAD) and low ejection fraction. For CAF patients, the risk of AF recurrence increased with larger LAD and lower ejection fraction. Complications that resolved prior to discharge were observed in nine patients (2.1%) with no strokes/transient ischemic attacks (TIAs).

Conclusion: The ablation of symptomatic PAF and CAF with multielectrode phased radiofrequency/duty-cycled ablation catheters shows long-term safety and effectiveness with relatively short procedure times.

Thanks for this article from Italy.

I am surprised at the 62 minute procedure time. I was lead to believe it is much longer?

Mine was 2 hrs 20 mins for PVI so I guess I don't understand that either unless they are somehow measuring it differently.
The abstract doesn't say what was ablated, but if it was a short procedure time I would have thought it indicated just a PVI.

Any opinions on this?

Has the Time Come to Abandon the Concept That “Pulmonary Vein Isolation Is the Cornerstone of Atrial Fibrillation Ablation”?


[circep.ahajournals.org]

(Pulmonary antrum radial-linear ablation (PAR) as compared with standard circumferential PVI

In the present issue of Circulation: Arrhythmia and Electrophysiology, Zhao et al2 report the results of a prospective randomized multicenter clinical trial examining the relative efficacy and safety of a novel non-PVI-based ablation strategy, referred to as pulmonary antrum radial-linear ablation (PAR) as compared with standard circumferential PVI for treatment of patients with paroxysmal AF. Forty-two patients underwent PAR ablation and 42 underwent PVI. These patients were followed closely at 3-month intervals using 3-day event and 24-hour Holter monitors. Ablation success was defined in accordance with the Heart Rhythm Society/EHRA/ECAS Consensus Document as freedom from AF, flutter, tachycardia lasting 30 seconds or longer after a 3-month blanking period.1 At 14 months of follow-up after a single procedure, 31 of 42 patients (74%) in the PAR ablation group had experienced no AF recurrence as compared with 22 of 44 patients (50%) treated with PVI. No major complications were observed in either arm of the study. …