Radiofrequency catheter ablation seems to be more effective than medical therapy as first-line treatment of paroxysmal AF in relatively young and otherwise healthy patients, but may also cause more severe adverse effects. These findings support the use of RFA as first-line therapy in selected patients, who understand the benefits and risks of the procedure.

Transseptal puncture and AF ablation can be performed safely in patients with ongoing OAT without intracardiac echocardiographic guidance and ACT monitoring.

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Abstract:Aims: Due to frequent relapses after initial ablation, there is need to develop accurate and practical preoperative means to predict atrial fibrillation (AF) ablation outcome. Methods:We evaluated the power of diastolic echocardiographic parameters in predicting the outcome of AF ablation. Forty-nine patients with symptomatic and drug-resistant paroxysmal or persistent AF, who underwent wide circumferential pulmonary vein isolation, were included in the study. Clinical and echocardiographic (e.g., left atrial size, left ventricular size and ejection fraction and several diastolic parameters) data were collected prospectively.Results: After single ablation procedure, 18 patients (37%) were free of AF without antiarrhythmic medication (group 1), whereas 31patients had symptomatic or asymptomatic AF relapses or needed antiarrhythmic medication (group 2) during the 12 months follow-up period. There was no difference in age (52±8 vs 54± 8years), body mass index (26 ± 4 vs 28 ± 4), comorbidity and procedural factors between the groups, but history of cardioversion was more common in group 2 (73% vs 39%, P = 0.032). In multivariate analysis, elevated ratio of early diastolic mitral flow velocity and mitral annular early diastolic velocity (E/e' ratio) was the most powerful predictor of AF recurrence (OR 1.911; 95% CI 1. 046-3.493, P=0.035).Conclusions: In our study, diastolic dysfunction measured by E/e' ratio was an independent predictor of AF recurrence after ablation. As a non-invasive and readily available measurement, the E/e´ratio may help to identify the patients in risk for treatment failure and to refine treatment strategy.