title: Catheter ablation of atrial fibrillation guided by a 3D electroanatomical mapping system: a 2-year follow-up study from the Italian Registry On NavX Atrial Fibrillation ablation procedures (IRON-AF).
abstract: OBJECTIVE
  Clinical trials have established that atrial fibrillation (AF) catheter ablation improves symptoms in appropriately selected patients. Confirmation of these results by long-term prospective observational studies is needed. This registry was created to describe the experience of 16 Italian centers with a large cohort of AF patients treated with catheter ablation guided by the NavX 3D mapping system.
  
  
  METHODS
  From November 2006 to May 2008, 545 consecutive patients (age 60.4 ± 9.8, 67 % male) with paroxysmal (44 %), persistent (43 %), and long-standing persistent (13 %) AF referred for catheter ablation guided by the NavX system, were included in this registry. For this paper, follow-up was censored at 24 months; however, patients are being followed in the ongoing registry.
  
  
  RESULTS
  Before the ablation, 80 % of patients failed to respond to at least one antiarrhythmic drug aimed at rhythm control. Pulmonary vein (PV) isolation guided by a circular mapping catheter was performed in 70 % of patients whereas non potential-guided PV encircling was performed in 30 % of patients. In 67 % of patients, additional left atrial (LA) substrate modification was performed. Image integration was performed in 9.2 % of patients. Considering a 3-month blanking period, after a single-ablation procedure, the patients had 1- and 2-year freedom from AF recurrence of 67.4 and 57.0 % (36.1 % off antiarrhythmic drugs), respectively. Cox regression analysis showed that AF recurrences during blanking (HR 2.1), and previous AF ablation (HR 3.3) were independent predictors of AF recurrences. Major procedure-related complications occurred in 53 patients (9.7 %). In 35 patients (6.7 %), a repeat procedure was performed at a median of 5 months after the initial procedure.
  
  
  CONCLUSIONS
  This prospective, multicenter clinical experience provides significant insights into current ablation care of patients with AF. Despite favorable outcomes, real-world complication rates appear higher than previously recognized.
authors: Division of Cardiology, Policlinico Universitario Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy. forleo@me.com
authors: Giovanni B
authors: GB
authors: Forleo
authors: Giuseppe
authors: G
authors: De Martino
authors: Massimo
authors: M
authors: Mantica
authors: Endrj
authors: E
authors: Menardi
authors: Nicola
authors: N
authors: Trevisi
authors: Massimiliano
authors: M
authors: Faustino
authors: Carmine
authors: C
authors: Muto
authors: Francesco
authors: F
authors: Perna
authors: Matteo
authors: M
authors: Santamaria
authors: Claudio
authors: C
authors: Pandozi
authors: Augusto
authors: A
authors: Pappalardo
authors: Carmine
authors: C
authors: Mancusi
authors: Enrico
authors: E
authors: Romano
authors: Paolo
authors: P
authors: Della Bella
authors: Claudio
authors: C
authors: Tondo
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
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