Efforts to Enhance Catheter Stability Improve Atrial Fibrillation Ablation Outcome.

Cardiovascular Division, Department of Medicine
Heart rhythm: the official journal of the Heart Rhythm Society (Impact Factor: 5.08). 11/2012; 10(3). DOI: 10.1016/j.hrthm.2012.10.044
Source: PubMed


BACKGROUND: Contemporary techniques to enhance anatomical detail and catheter contact during atrial fibrillation ablation include: 1) the integration of pre-acquired tomographic reconstructions with electroanatomical mapping (I-EAM); 2) the use streerable introducers (SI); and 3) high frequency jet ventilation (HFJV). OBJECTIVE: We hypothesized that using these stabilizing techniques during AF ablation would improve 1-year procedural outcome. METHODS: We studied 300 patients undergoing AF ablation at our institution. Patients were assigned to three equal treatment groups (100 patients each) based upon the tools utilized: 1) Group 1- AF ablation performed without I-EAM, SI or HFJV; 2) Group 2- AF ablation performed using I-EAM and SI, but without HFJV; and 3) Group 3- AF ablation performed with I-EAM, SI, and HFJV. The primary outcome was freedom from AF 1-year after a single ablation procedure. The burden of both acute and chronic PV reconnection was also assessed. RESULTS: Patients from Groups 2 and 3 had significantly more non-paroxysmal AF (17% vs. 30% vs. 39%, p=0.002), larger left atria (4.2±0.8 vs. 4.4±0.7 vs. 4.5±0.8 cm, p<0.001), and higher BMI (28.5±5.8 vs. 29.1±4.8 vs. 31.2±5.4, p<0.001). Despite these differences, with adoption of I-EAM, SI, and HFJV we noted a significant improvement in 1-year freedom from AF (52% vs. 66% vs. 74%; p=0.006) as well as fewer acute (1.1±1.2 vs. 0.9±1.1 vs. 0.6±0.9, p=0.03) and chronic (3.5±0.9 vs. 3.2±0.9 vs. 2.4±1.0, p=0.02) PV reconnections. CONCLUSIONS: The incorporation of contemporary tools to enhance anatomical detail and ablation catheter stability significantly improved 1-year freedom from AF after ablation.

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    ABSTRACT: Catheter ablation of atrial fibrillation (AF) has become an important treatment method. Electrical isolation of the pulmonary veins is the cornerstone of most AF ablation procedures, and is defined by an entrance block observed on a circular multipolar electrode catheter. The safety and efficacy of AF ablation is best established in middle-aged patients with paroxysmal AF. Current guidelines recommend AF ablation with a level Ia indication in this group of patients. The long-term efficacy of AF ablation is well established in patients with paroxysmal AF, but less so in patients with longstanding persistent AF. In this population, current guidelines recommend AF ablation with a level IIb indication. The efficacy of catheter ablation in other patient populations, particularly elderly people and those with concomitant conditions, is also poorly defined. AF ablation is reasonably effective and safe at 12 months of follow-up, but recurrence of AF ≥1 year after ablation is not uncommon. Fortunately, the techniques and tools used for AF ablation continue to evolve. These developments include novel ablation catheters designed to increase safety, efficacy, and precision of the procedure, ablation strategies to target both pulmonary vein and nonpulmonary vein AF triggers, and improved imaging and electrical mapping to guide ablation procedures.
    Nature Reviews Cardiology 08/2013; 10(10). DOI:10.1038/nrcardio.2013.121 · 9.18 Impact Factor

  • Heart rhythm: the official journal of the Heart Rhythm Society 12/2013; 11(3). DOI:10.1016/j.hrthm.2013.12.026 · 5.08 Impact Factor
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