Circumferential pulmonary vein RF ablation in the treatment of atrial fibrillation: 3-year experience of one centre.
BACKGROUND
In patients with atrial fibrillation (AF), significantly symptomatic in particular, restoring and maintaining sinus rhythm is one of treatment strategies. Considering the limited efficacy and side effects of anti-arrhythmic agents, growing hopes are attributed to the developing techniques of percutaneous ablation.


OBJECTIVE
To determine the efficacy and safety of circumferential pulmonary vein ablation performed using the CARTO system in patients with paroxysmal or permanent AF.


METHODS
The study involved 94 patients (mean age 54 years, males 65%, structural heart disease 29.4%) with symptomatic, recurrent and AF resistant to antiarrhythmic agents (paroxysmal AF 63.8%), selected for circumferential pulmonary vein ablation with the Pappone method. Follow-up examinations were performed after 1, 3, 6, 9, and 12 months. The symptoms, ECG, 24-hour ECG monitoring and complications were recorded.


RESULTS
Mean procedure and fluoroscopy durations were 4.5 hours and 22.4 minutes respectively. The long-term follow-up ranged from 3 to 24 months, with median time of 12 months. At six months, 47.8% of patients remained free from AF, and improvement in terms of infrequent arrhythmia occurrence and low incidence of symptoms in an additional 36.7% was observed. Efficacy was lower in patients with permanent AF (12 months 90% vs 70%). Complications were seen in six (6.4%) patients: cardiac tamponade in two patients; and pericardial effusion, retroperitoneal bleeding, stroke, and pulmonary vein thrombosis each in one patient.


CONCLUSIONS
Circumferential pulmonary vein ablation leads to resolution of arrhythmia or marked clinical improvement in about 75% of patients with symptomatic, resistant AF. The success rate is lower in patients with permanent rather than paroxysmal AF. As severe complications are not unlikely, the indications for such therapy must be carefully balanced.
Wnuk-Wojnar
Anna-Maria
AM
1st Chair and Department of Cardiology, Medical University of Silesia, Katowice, Poland. trusz@cathlab.katowice.pl
Trusz-Gluza
Maria
M
Czerwiński
Cezary
C
Woźniak-Skowerska
Iwona
I
Szydło
Krzysztof
K
Hoffman
Andrzej
A
Nowak
Seweryn
S
Wita
Krystian
K
Konarska-Kuszewska
Ewa
E
Krauze
Jolanta
J
Rybicka-Musialik
Anna
A
Drzewiecka-Gerber
Agnieszka
A
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome