Emanuele Bertaglia1, Giuseppe Stabile2, Gaetano Senatore3, Claudio Pratola4, Roberto Verlato5, Martin Lowe6, Pekka Raatikainen7, Filippo Lamberti8, Pietro Turco9. 1. Department of Cardiological, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy. Electronic address: emanuele.bertaglia@sanita.padova.it. 2. Casa di Cura Mediterranea, Napoli, Italy. 3. Ospedale Civile, Ciriè, Italy. 4. Ospedale Sant'Anna, Ferrara, Italy. 5. Ospedale Civile Cosma, Camposampiero, Italy. 6. Heart Hospital, London, United Kingdom. 7. University of Tampere, Tampere, Finland. 8. Ospedale San Giovanni, Roma, Italy. 9. Casa di Cura San Michele, Maddaloni, Italy.
Abstract
BACKGROUND: The aim of this study was to investigate the efficacy of catheter ablation in the treatment of persistent atrial fibrillation (AF) and the predictors of arrhythmia recurrence. METHODS:Absence of atrial tachyarrhythmia (AT) recurrence during a mid-term follow-up was correlated with several clinical and procedural characteristics in a population of 82 patients aged 20-70 years who had experienced at least one documented relapse of persistent AF during a single trial of antiarrhythmic drug therapy. Electrophysiological success of ablation was declared when all identified PVs were isolated (confirmation of entry and exit block). Patients were followed for a maximum of 24 months after the blanking period with outpatient visits, ECG recordings, 24-hour Holter monitoring, and weekly transtelephonic monitoring for 30s. RESULTS:Electrophysiological success was documented in 38/82 (46.3%) patients. During a mean follow-up of 24.7 ± 4.2 months, 69/82 (84.1%) patients presented at least one episode of AT after the 2 month blanking period. According to univariate and multivariate logistic regression analyses, only an electrophysiologically successful ablation significantly correlated with the absence of documented AT relapse (OR 5.32, 95% CL 1.02-27.72; p=.0472). CONCLUSIONS: Mid-term outcome of a single procedure of catheter ablation without the adjunction of antiarrhythmic drug therapy is poor in patients with persistent AF. Documented PV isolation is useful to increase the success rate of circumferential PV ablation even in persistent AF patients.
RCT Entities:
BACKGROUND: The aim of this study was to investigate the efficacy of catheter ablation in the treatment of persistent atrial fibrillation (AF) and the predictors of arrhythmia recurrence. METHODS: Absence of atrial tachyarrhythmia (AT) recurrence during a mid-term follow-up was correlated with several clinical and procedural characteristics in a population of 82 patients aged 20-70 years who had experienced at least one documented relapse of persistent AF during a single trial of antiarrhythmic drug therapy. Electrophysiological success of ablation was declared when all identified PVs were isolated (confirmation of entry and exit block). Patients were followed for a maximum of 24 months after the blanking period with outpatient visits, ECG recordings, 24-hour Holter monitoring, and weekly transtelephonic monitoring for 30s. RESULTS: Electrophysiological success was documented in 38/82 (46.3%) patients. During a mean follow-up of 24.7 ± 4.2 months, 69/82 (84.1%) patients presented at least one episode of AT after the 2 month blanking period. According to univariate and multivariate logistic regression analyses, only an electrophysiologically successful ablation significantly correlated with the absence of documented AT relapse (OR 5.32, 95% CL 1.02-27.72; p=.0472). CONCLUSIONS: Mid-term outcome of a single procedure of catheter ablation without the adjunction of antiarrhythmic drug therapy is poor in patients with persistent AF. Documented PV isolation is useful to increase the success rate of circumferential PV ablation even in persistent AFpatients.
Authors: Luigi Sciarra; Saverio Iacopino; Zefferino Palamà; Ermenegildo De Ruvo; Pasquale Filannino; Alessio Borrelli; Paolo Artale; Alberto Caragliano; Antonio Scarà; Paolo Golia; Lucia De Luca; Domenico Grieco; Marco Rebecchi; Stefano Favale; Leonardo Calò Journal: Indian Pacing Electrophysiol J Date: 2018-02-22