Comparison of catheter ablation and surgical ablation in patients with long-standing persistent atrial fibrillation and rheumatic heart disease: a four-year follow-up study.

BACKGROUND: In our previous prospective and randomized study, we have demonstrated that the concomitant surgical ablation using saline-irrigated cooled tip radiofrequency ablation (SICTRA) system is more effective than subsequent circumferential pulmonary vein isolation (CPVI) combined with substrate modification in treating patients with long-standing persistent atrial fibrillation (LS-AF) and rheumatic heart disease (RHD) undergoing cardiac surgery during middle-term follow-up. Whether this strategy also decreases longer-term arrhythmia recurrence is unknown. This study describes the 4-year efficacy of SICTRA for these patients. Furthermore, we seek to compare the electrophysiological characteristics for recurrent atrial tachyarrhythmia (ATa) at the session of catheter ablation between two groups.
METHODS: Long-term follow-up was performed in 95 patients who underwent the catheter ablation strategy (n=47, Group A) or SICTRA (n=48, Group B) combined with valvular surgery for symptomatic LS-AF patients with RHD.
RESULTS: After one procedure, Group B had a significantly higher freedom from ATa compared with Group A (29/48 vs 15/47, P=0.005) after a mean follow-up of 54 months (range 48 to 63 months). Catheter-based mapping and ablation of recurrent ATa showed larger amounts of macro-reentrant atrial tachycardias (ATs) in Group B and higher incidence of pulmonary vein (PV) recovery in Group A. After multiple catheter ablations for recurrent ATa, sinus rhythm (SR) could be maintained equally between two groups.
CONCLUSIONS: Single procedure success seems to be higher with SICTRA but repeated catheter ablation potentially results in comparable outcomes in treating patients with LS-AF and RHD during long-term follow-up. More macro-reentrant ATs and more PV recoveries are identified to be responsible for ATa in SICTRA and catheter ablation group, respectively.

RCT Entities:   Population Interventions Outcomes