Ablation of Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered by cardiologists and is a major cause of morbidity and mortality. Risk factors for AF include age, male sex, genetic predisposition, hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, heart failure, and possibly excessive exercise. The management of AF involves decisions about rate versus rhythm control. Asymptomatic patients are generally managed with rate control and anticoagulation. Symptomatic patients will desire rhythm control. Rhythm control options are either antiarrhythmic agents or ablation, with each having its own risks and benefits. Ablation of AF has evolved from a rare and complex procedure to a common electrophysiological technique. Selection of patients to undergo ablation is an important aspect of AF care. Patients with the highest success rates of ablation are those with normal structural hearts and paroxysmal AF, although those with congestive heart failure have the greatest potential benefit of the procedure. Although pulmonary vein isolation of any means/energy source is the approach generally agreed on for those with paroxysmal AF, optimal techniques for the ablation of nonparoxysmal AF are not yet clear. Anticoagulation reduces thromboembolic complications; the newer anticoagulants have eased management for both the patient and the cardiologist. Aggressive management of modifiable risk factors (hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, and possibly excessive exercise) after ablation reduces the odds of recurrent AF and is an important element of care.

Perioperative Outcomes and Safety of Atrial Fibrillation Catheter Ablation in Octogenarians: A Retrospective Study and Review of the Benefits of Rhythm Control

“…Bunch et al [12] evaluated the chronicity of AF and gender and concluded that gender did not influence the outcomes/need for reablation whereas the chronicity of AF did. Natale and colleagues, in a recent review of AF ablation, describes the “ideal patient with highest likelihood of procedural success” [13]. This patient would have only paroxysmal AF, no cardiac disease, and a nondilated left atrium [13].…”

“…Natale and colleagues, in a recent review of AF ablation, describes the “ideal patient with highest likelihood of procedural success” [13]. This patient would have only paroxysmal AF, no cardiac disease, and a nondilated left atrium [13]. However, patients who do not meet the mentioned criteria might also benefit from the procedure; this includes patients with HF [13].…”

“…This patient would have only paroxysmal AF, no cardiac disease, and a nondilated left atrium [13]. However, patients who do not meet the mentioned criteria might also benefit from the procedure; this includes patients with HF [13]. Natale and colleagues [13 ]suggest that AF ablation should be considered as first-line therapy if the HF is felt to be resultant from the AF.…”

“…However, patients who do not meet the mentioned criteria might also benefit from the procedure; this includes patients with HF [13]. Natale and colleagues [13 ]suggest that AF ablation should be considered as first-line therapy if the HF is felt to be resultant from the AF. Current practice guidelines suggest that there is no long-term survival benefit of rate and rhythm control in AF management, leading to more focus on rate control than on rhythm in AF [4,19].…”

“…Given the aging of the population and the projected increasing prevalence of AF [1], determining the safety and efficacy of this procedure in this age group is of the utmost importance. Smaller-scale studies have evaluated AF catheter ablation in elderly patients, showing an apparent benefit and safety [10,11,12,13,14]. In this study, we report the procedural success rate and safety and periprocedural outcomes of octogenarians undergoing AF ablation in a community hospital setting.…”