Pradeep Kumar Hasija1, Prashant Bhardwaj2, Anup Banerji3. 1. MG Med, HQ Dakshin Bharat Area, India. 2. Additional Director General Medical Services (Army), IHQ, MOD, 'L' Block, New Delhi, India. 3. Director General Armed Forces Medical Services & Senior Colonel Commandant, O/o DGAFMS, MOD, 'M' Block, New Delhi, India.
Abstract
BACKGROUND: Complex arrhythmia ablation remains a technical challenge despite advances in hardware and mapping techniques. The aim of the study was to analyse the efficacy of radiofrequency ablation of arrhythmias requiring complex electrophysiological procedures at a tertiary-care centre. METHODS: A retrospective study was done for catheter ablation of arrhythmias performed at a single centre from Aug 2012 to Nov 2016 (4 years 4 months). The standard ablation involved conventional catheters with antegrade right heart and retrograde left heart access. The procedure was considered complex, if it involved 3 D electro-anatomical (EA) guidance for mapping or required special hardware and/or trans-septal puncture. RESULTS: Of 333 electrophysiology (EP) cases 265 qualified for ablation. The cohort of arrhythmias requiring complex procedure (n = 94) comprised of supraventricular 15 (15.9%), atrioventricular 43 (44.7%) and ventricular 36 (38.3%). The procedure used three-dimensional EA mapping in 31; trans-septal puncture for left atrial access in 40; and use of special catheters and sheaths in all 94 procedures. The overall success in the complex group after the first procedure was 87.2% versus 88.3% (P < 0.05), and after redo procedure it was 90.4% vs 94.7% (P < 0.05). There were three complications (pericardial perforation: 2; cardioembolism: 1) only in the complex group. The fluoroscopy time for complex was longer than that of the standard procedure (25.10 ± 6.32 versus 15.23 ± 5.33 min, P = 2.54). CONCLUSION: Arrhythmias requiring complex electrophysiological procedure for ablation have a comparable success rate to standard ablation procedure but at the cost of extra hardware, complications and fluoroscopy time.
BACKGROUND: Complex arrhythmia ablation remains a technical challenge despite advances in hardware and mapping techniques. The aim of the study was to analyse the efficacy of radiofrequency ablation of arrhythmias requiring complex electrophysiological procedures at a tertiary-care centre. METHODS: A retrospective study was done for catheter ablation of arrhythmias performed at a single centre from Aug 2012 to Nov 2016 (4 years 4 months). The standard ablation involved conventional catheters with antegrade right heart and retrograde left heart access. The procedure was considered complex, if it involved 3 D electro-anatomical (EA) guidance for mapping or required special hardware and/or trans-septal puncture. RESULTS: Of 333 electrophysiology (EP) cases 265 qualified for ablation. The cohort of arrhythmias requiring complex procedure (n = 94) comprised of supraventricular 15 (15.9%), atrioventricular 43 (44.7%) and ventricular 36 (38.3%). The procedure used three-dimensional EA mapping in 31; trans-septal puncture for left atrial access in 40; and use of special catheters and sheaths in all 94 procedures. The overall success in the complex group after the first procedure was 87.2% versus 88.3% (P < 0.05), and after redo procedure it was 90.4% vs 94.7% (P < 0.05). There were three complications (pericardial perforation: 2; cardioembolism: 1) only in the complex group. The fluoroscopy time for complex was longer than that of the standard procedure (25.10 ± 6.32 versus 15.23 ± 5.33 min, P = 2.54). CONCLUSION: Arrhythmias requiring complex electrophysiological procedure for ablation have a comparable success rate to standard ablation procedure but at the cost of extra hardware, complications and fluoroscopy time.
Authors: W M Jackman; X Z Wang; K J Friday; C A Roman; K P Moulton; K J Beckman; J H McClelland; N Twidale; H A Hazlitt; M I Prior Journal: N Engl J Med Date: 1991-06-06 Impact factor: 91.245
Authors: Marius Bohnen; William G Stevenson; Usha B Tedrow; Gregory F Michaud; Roy M John; Laurence M Epstein; Christine M Albert; Bruce A Koplan Journal: Heart Rhythm Date: 2011-05-27 Impact factor: 6.343
Authors: Paolo Della Bella; Josep Brugada; Katja Zeppenfeld; Jose Merino; Petr Neuzil; Philippe Maury; Giuseppe Maccabelli; Pasquale Vergara; Francesca Baratto; Antonio Berruezo; Adrianus P Wijnmaalen Journal: Circ Arrhythm Electrophysiol Date: 2011-08-13