Radiofrequency atrial fibrillation ablation based on pathophysiology: a diversified protocol with long-term follow-up.
BACKGROUND
The optimal approach and long-term results of radiofrequency catheter ablation of atrial fibrillation (AF) are still unknown. We report our experience with respect to an ablation protocol diversified on a patient's AF pathophysiology with long-term follow-up.


METHODS
Seventy-two patients with paroxysmal/persistent drug-resistant AF were selected. Patients with apparently normal hearts (group 1, n = 20) underwent electrophysiological disconnection of pulmonary veins (PVs) presenting a clear PV potential, whereas those with even initial cardiopathy (group 2, n = 52), underwent PV encircling.


RESULTS
Sinus rhythm was maintained at 6 months in 85% of group 1 and 71% of group 2 patients. After 42 months of follow-up, including 15.2% re-do procedures, 85% of group 1 and 77% of group 2 patients were in sinus rhythm, including patients with anti-arrhythmic drugs (AADs). The long-term success rate without AADs was 75% and 46% for each group, respectively. Age and the 6-month success of the procedure were predictive of sinus rhythm maintenance during follow-up.


CONCLUSIONS
An ablation protocol diversified on AF pathophysiology assured, at 3 years of follow-up, sinus rhythm maintenance in 85% of patients with a normal heart and in 77% of those with even initial cardiopathy. The 6-month result of the ablation procedure remained stable over time.
Pratola
Claudio
C
Chair of Cardiology S. Anna University Hospital, Ferrara, Italy.
Baldo
Elisa
E
Notarstefano
Pasquale
P
Toselli
Tiziano
T
Ferrari
Roberto
R
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome