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Immediate and long‑term results of conventionally performed radiofrequency catheter ablations of paroxysmal atrial fibrillation


Authors: R. Lábrová;  M. Fiala;  O. Toman;  J. Špinar
Authors place of work: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC
Published in the journal: Vnitř Lék 2008; 54(10): 953-960
Category: Original Contributions

Summary

Introduction:
Atrial fibrillation is the most frequent cardiac arrhythmia. Epidemiological studies show sharp increase of incidence and prevalence of atrial fibrillation all over the world. Atrial fibrillation is becoming to be a serious problem, not only clinical, but even social and economical. Aim of the paper was to evaluate immediate and long‑term results of radiofrequency catheter ablation of paroxysmal atrial fibrillation at Dpt. of Internal Medicine – Cardiology, University Hospital Brno.

Methods:
The patients were indicated for ablation, when the anti‑arrhythmic therapy was ineffective. End-point of the ablation was disconnection of myocardial sleeves between left atrium and pulmonary veins and complete electrical isolation of pulmonary veins.

Group of the patients, results:
There were 67 catheter ablations of paroxysmal atrial fibrillation performed within the years 9/2004 to 12/2006 at our department, out of the whole amount of 1,285 ablations of supraventricular tachyarrhythmias from 1995 to 2006. There were 27 women (40%) and 40 men (60%) in our group of patients, with the mean age 56.9 ± 9.5 years. The average ejection fraction of left ventricle was 62 ± 5%, left atrial dimension 42.8 ± 6 mm. The mean follow‑up period was 16.9 ± 10.9 months. The patients were treated before and after the ablation by 1 anti‑arrhythmic drug in 44.8 vs 50%, by 2 drugs in 40.3 vs 14.9% and by 3 drugs in 10.4 vs 9%, respectively. The percentage of patients without any anti‑arrhythmic drug increased after successful ablation from 2.9 to 25.4%, the percentage of patients using amiodarone decreased from 29.8 to 16.4%, propafenon from 29.8 to 16.4% and sotalol from 26.8 to 10.4% respectively. The median of RF application duration was 43.8 min, fluoroscopy time 43.8 min and procedure duration 240 min. The success rates were 87.5% in year 2004, 77.4% in 2005 and 79.2% in 2006.

Conclusion:
Catheter ablation of paroxysmal atrial fibrillation has become a routine curative method in symptomatic patients without major structural heart disease, with ineffective anti‑arrhythmic treatment. Ablation was associated with significant reduction of anti‑arrhythmic and anticoagulation therapy.

Key words:
atrial fibrillation – paroxysmal atrial fibrillation – radiofrequency catheter ablation – electrical isolation of pulmonary veins


Zdroje

1. Cappato R, Calkins H, Chen SA et al. Worldwide survey on the methods, efficacy and safety of catheter ablation for human atrial fibrillation. Circulation 2005; 111: 1100–1105.

2. Fiala M, Chovančík J, Heinz P et al. Léčba symptomatické intermitentní fibrilace síní katetrovou ablací v levé srdeční síni: bezprostřední a dlouhodobé výsledky u 150 pacientů. Vnitř Lék 2005; 51: 971–983.

3. Fiala M, Chovančík J, Moravec R et al. Recidivující arytmie po katetrové ablaci původně paroxysmální fibrilace síní a výsledky opakované ablace. Vnitř Lék 2007; 53: 1248–1254.

4. Fiala M, Chovančík J, Nevřalová R et al. Pulmonary vein isolation using segmental versus electroanatomical circumferential ablation for paroxysmal atrial fibrillation: over 3-year results of a prospective randomized study. J Interv Card Electrophysiol 2008; přijato k publikaci.

5. Fuster V, Ryden LE, Cannom DS et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: executive summary. Circulation 2006; 114: 700–752.

6. Gammage MD, Parle JV, Holder RL et al. Association between serum free thyrosine concentration and atrial fibrillation. Arch Intern Med 2007; 167: 928–934.

7. Gersh BJ, Tsang TSM, Seward JB. The changing epidemiology and natural history of nonvalvular atrial fibrillation: clinical implications. Trans Am Clin Climatol Assoc 2004; 114: 149–160.

8. Haissaguerre M, Jais P, Shah DC et al. Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 1996; 7: 1132–1144.

9. Haissaguerre M, Shah DC, Jais P et al. Electrophysiological break--throughs from the left atrium to the pulmonary veins. Circulation 2000; 101: 1409–1417.

10. Kumaraswamy H, Plumb VJ, Epstein AE et al. Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy. Circulation 2004, 111: 546–554.

11. Lábrová R. Epidemilogie fibrilace síní. KF 2007; 5: 6–10.

12. Lábrová R. Léčba fibrilace síní v době katetrové ablace. Vnitř Lék 2007; 53: 923–924.

13. Marrouche NF, Dresing T, Cole C et al. Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation. J Am Coll Cardiol 2002; 40: 464–474.

14. Matsumoto N, Ryoji K, Kasugai H et al. Experimental study on the effectiveness and safety of radiofrequency catheter ablation with the cooled ablation system. Circ J 2003; 67: 154–158.

15. McGovern PG, Jacobs DR Jr, Shahar E et al. Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota Heart Survey. Circulation 2001; 104: 19–24.

16. Oral H, Scharf C, Chugh A et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003; 108: 2355–2360.

17. Pedersen OD, Kober L, Torp-Pedersen C. Atrial fibrillation and atrial cardiomyo-pathy: two sides of the same coin? Am Heart J 2004; 147: 953–955.

18. Pürerfellner H, Cihal R, Aichinger J et al. Pulmonary vein stenosis by ostial irrigated-tip ablation: Incidence, time course, and prediction. J Cardiovasc Elec-trophysiol 2003; 14: 158–164.

19. Redfield MM, Jacobsen SJ, Burnett JC Jr et al. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003; 289: 194–202.  

20. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized, controlled trials. Arch Intern Med 1994; 154: 1449–1457.

21. Stewart S, Murphy N, Walker A et al. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart 2004; 90: 286–292.  

22. Špinar J, Vítovec J. Losartan – víc než pokles krevního tlaku. Kardiol Rev 2006; 8: 115–120.

23. Tsang TS, Gersh BJ, Appleton CP. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 2002; 40: 1636–1644.

24. Tsang TS, Petty GW, Barnes ME et al. The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. J Am Coll Cardiol 2003; 42: 93–100.  

25. Verma A, Wazni OM, Marrouche NF et al. Pre‑existing left atrial scaring in patients undergoing pulmonary vein antrum isolation. An independent predictor of procedural failure. J Am Coll Cardiol 2005; 45: 285–292.

26. Wang TJ, Larson MG, Levy D et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 2003; 107: 2920–2925.  

27. Watanabe I, Masaki R, Min N et al. Cooled tip ablation results in increased radiofrequency power delivery and lesion size in the canine heart. Importance of catheter-tip temperature monitoring for prevention of popping and impedance rise. J Int Cardiac Electrophysiol 2002; 6: 9–16.

28. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983–988.  

29. Wolf PA, Benjamin EJ, Belanger AJ et al. Secular trends in the prevalence of atrial fibrillation: the Framingham Study.Am Heart J 1996; 131: 790–795.

Štítky
Diabetology Endocrinology Internal medicine
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