Percutaneous ablation of atrial fibrillation: assessment of outcomes at 1-year follow-up.
OBJECTIVE
Current non-pharmacologic treatment strategies for atrial fibrillation (AF) involve discrete ablation of ectopic foci or isolation of the pulmonary vein (PV) ostia, which have been implicated in the genesis of this rhythm disorder. The aim of this study was to determine intermediate and long-term outcomes after percutaneous AF ablation and predictors of successful treatment.


METHODS
We studied 29 consecutive patients (72% male, mean age 52.3 +/- 13 years) who underwent percutaneous ablation of AF refractory to antiarrhythmic drug therapy. AF was idiopathic in 22 patients and the remaining 7 patients were hypertensive. Six patients had permanent AF and the others had recurrent paroxysmal AF (with at least 1 episode a week). Left atrial size was 40.3 +/- 6.1 mm. A total of 35 ablation procedures were performed, 12 using the focal ablation technique and 23 by PV isolation. Six patients underwent a redo procedure. Patients were evaluated at 1-year follow-up (symptoms, medication, ECG and Holter monitoring). Predictors of successful treatment were identified among baseline clinical variables (age, gender, hypertension), LA size, AF sub-type, ablation technique, and number of isolated PV, using multivariable logistic regression.


RESULTS
At 1-year follow-up, 20 patients presented sinus rhythm (69%), of whom 7 were taking antiarrhythmic drugs and remained free of AF relapse. Out of the total of 35 procedures, 2 immediate complications occurred: pericardial tamponade in one patient and right phrenic nerve palsy in another. Predictors of long-term success were absence of a prior history of hypertension and isolation of at least three PV (p = 0.01 for both independent predictors).


CONCLUSIONS
Two out of three patients who underwent AF ablation presented sinus rhythm one year after the intervention. Isolation of at least three PV and idiopathic etiology are independent predictors of successful treatment.
Adragão
Pedro Pulido
PP
Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal. padragao@netcabo.pt
Cavaco
Diogo Magalhães
DM
Santos
Katya Reis
KR
Aguiar
Carlos
C
Raposo
Luís
L
Morgado
Francisco Bello
FB
Neves
José Pedro
JP
Abecasis
Miguel
M
Chotalal
Dipali
D
Bonhorst
Daniel
D
Gomes
Ricardo Seabra
RS
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors