European survey on efficacy and safety of duty-cycled radiofrequency ablation for atrial fibrillation

Abstract

AimsDuty-cycled radiofrequency ablation (RFA) has been used for atrial fibrillation (AF) for around 5 years, but large-scale data are scarce. The purpose of this survey was to report the outcome of the technique.Methods and resultsA survey was conducted among 20 centres from seven European countries including 2748 patients (2128 with paroxysmal and 620 with persistent AF). In paroxysmal AF an overall success rate of 82% [median 80%, interquartile range (IQR) 74–90%], a first procedure success rate of 72% [median 74% (IQR 59–83%)], and a success of antiarrhythmic medication of 59% [median 60% (IQR 39–72%)] was reported. In persistent AF, success rates were significantly lower with 70% [median 74% (IQR 60–92%)]; P = 0.05) as well as the first procedure success rate of 58% [median 55% (IQR 47–81%)]; P = 0.001). The overall success rate was similar among higher and lower volume centres and were not dependent on the duration of experience with duty-cycled RFA (r = −0.08, P = 0.72). Complications were observed in 108 (3.9%) patients, including 31 (1.1%) with symptomatic transient ischaemic attack or stroke, which had the same incidence in paroxysmal and persistent AF (1.1 vs. 1.1%) and was unrelated to the case load (r = 0.24, P = 0.15), bridging anticoagulation to low molecular heparin, routine administration of heparin over the long sheath, whether a transoesophageal echocardiogram was performed in every patient or not and average procedure times.ConclusionDuty-cycled RFA has a self-reported success and complication rate similar to conventional RFA. After technical modifications a prospective registry with controlled data monitoring should be conducted to assess outcome.

Multielectrode phased radiofrequency ablation compared with point-by-point ablation for pulmonary vein isolation – outcomes in 539 patients

“…Rates of around 1% neurologic events, including symptomatic transient ischemic attack/stroke, with duty-cycled RF ablation were recently reported in a large survey. 29 These rates are in the same range as those reported with conventional RF. 30,31 Asymptomatic cerebral infarction rates of ∼14% with irrigated-tip catheters have been reported.…”

Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation

“…These "single-shot" techniques were designed to create a circular ablation lesion around the PVs after the appropriate positioning of the ablation catheter at the ostium or at the antra of each PV. A number of studies have demonstrated comparable levels of success and safety profile, but shorter procedure times with these simplified methods than with the conventional point-by-point ablation [10][11][12][13].…”

Comparison of the Efficacy of PVAC® and nMARQ™ for paroxysmal atrial fibrillation

“…The European survey on the efficacy and safety of PVAC® [25] included twenty centers from seven European countries, 2748 patients (77% with PAF). The mean procedure time was 122 min for paroxysmal and 145 min for persistent AF (P = 0.08).…”

“…In the European survey on the efficacy and safety of PVAC® [25] (2128 patients with PAF, 620 persistent AF) 81% had a structured follow-up defined as routine Holter-ECG after a mean of 11.2 months. The survey found in PAF patients an overall success rate of 82% [median 80%, interquartile range (IQR) 74-90%], with a first procedure success rate of 72% [median 74% (IQR 59-83%)].…”