Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers

Citation
Ep. Gerstenfeld et al., Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers, J CARD ELEC, 12(8), 2001, pp. 900-908
Citations number
13
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
ISSN journal
1045-3873 → ACNP
Volume
12
Issue
8
Year of publication
2001
Pages
900 - 908
Database
ISI
SICI code
1045-3873(200108)12:8<900:COARCA>2.0.ZU;2-W
Abstract
Introduction: Ablative therapy for atrial fibrillation (AF) by targeting in itiating triggers, usually in or around the pulmonary veins, has been repor ted by several centers. Evidence for an overall improvement in quality of l ife (QOL) and amelioration of symptoms is lacking. Methods and Results: Seventy-one patients undergoing attempted ablation of focal AF were followed for 60 +/- 33 weeks. QOL and symptom questionnaires were completed 1 month before and 6 months after electrophysiologic study. Twenty-three patients (32%) underwent electrophysiologic mapping but no abl ation because of either insufficient or multifocal ectopy; the other 48 pat ients (68%) underwent attempted ablation. Sixteen of 48 patients (33%) unde rgoing ablation, or 16 (23%) of 71 on an intention-to-treat basis, were fou nd at last follow-up to have persistent sinus rhythm without antiarrhythmic drugs. Patients who underwent mapping without ablation reported no improve ments in any QOL or symptom score, whereas patients who had long-term succe ssful ablation had significant improvements in all six QOL measures. Intere stingly, patients who developed AF recurrence after ablation still reported significant improvements in 4 of 6 QOL measures. Four of 48 patients (8.3% ) undergoing ablation developed pulmonary vein stenosis. Conclusion: Paroxysmal AF can be treated successfully in some patients by a blating initiating triggers in the pulmonary veins; however, in our experie nce the recurrence rate (32/48 [68%]) and risk of pulmonary vein stenosis ( 8%) after ablation are high. Patients with recurrent AF after ablation of f ocal AF triggers have significant improvement in QOL and symptoms compared with before ablation. Patients and their physicians should carefully balanc e the risks and benefits before considering ablation.