Catheter ablation of permanent atrial fibrillation: medium term results

Abstract

Objective: To investigate the feasibility of catheter ablation as a treatment for symptomatic patients with longstanding permanent atrial fibrillation (AF).

Methods: Radiofrequency ablation was applied to encircle all pulmonary veins (PVs) and create lines from the left inferior PV to the mitral valve, along the roof of the left atrium between the PVs, and along the tricuspid valve-inferior vena cava isthmus. A seven day Holter was recorded at discharge and at follow up to assess arrhythmia burden. If patients developed a symptomatic, sustained atrial arrhythmia a repeat ablation procedure was advised.

Results: 42 patients underwent the procedure that took a mean of five hours with 50 minutes of fluoroscopy. After a median follow up of 8.4 months, 31 of 41 surviving patients (76%) were in sinus rhythm. Of these, 29 patients were no longer taking any antiarrhythmic drugs but 22 (52%) required more than one procedure. During follow up 49% experienced a sustained atrial tachycardia. Twenty six repeat procedures were performed. Maintenance of sinus rhythm after the first, second, or third procedure was 36% (15 of 42), 58% (11 of 19), and 71% (5 of 7), respectively. From a total of 68 procedures there were two serious complications (2.9%): a stroke from which a full recovery was made, and a PV stenosis.

Conclusion: Catheter ablation can be used to cure longstanding permanent AF; however, there is a significant complication rate. Whether this is offset by a mortality benefit associated with sinus rhythm is unknown. Many patients will need more than one procedure to achieve success.

Conflict of interest statement

Conflict of interest: Dr Earley has received payment for a lecture given on behalf of Endocardial Solutions. Dr Schilling is a member of the scientific advisory board for Biosense Webster. He is listed on the speakers' bureau for Endocardial Solutions and has received payment for lectures sponsored by them. He has received sponsorship for travel to international meetings from Guidant, Medtronic, St Jude Medical, Endocardial Solutions, and Biosense Webster. The other authors have no specific competing interests other than support for travel to international meetings from Guidant, Medtronic, St Jude Medical, Endocardial Solutions, and Biosense Webster.

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