Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Abstract

Introduction Long‐term efficacy and safety are uncertain in patients with cardiac implantable electronic devices (CIED) and transvenous leads (TVL) undergoing radiofrequency catheter ablation of atrial fibrillation (AF). Thus, we assessed the outcome of AF ablation in those patients during long‐term follow‐up using continuous atrial rhythm monitoring (CARM). Methods and Results A total of 190 patients (71.3 ± 10.7 years; 108 (56.8% men) were included in this study. At index procedure 81 (42.6%) patients presented with paroxysmal AF and 109 (57.4%) with persistent AF. The ablation strategy included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines, if appropriate. AF recurrences were assessed by CARM‐ and CIED‐related complications by device follow‐up. After a mean follow‐up of 55.4 ± 38.1 months, freedom of AF was found in 86 (61.4%) and clinical success defined as an AF burden less than or equal to 1% in 101 (72.1%) patients. Freedom of AF was reported in 74.6% and 51.9% (P = 0.006) and clinical success in 89.8% and 59.3% (P < 0.001) of patients with paroxysmal and persistent AF, respectively. In 3 of 408 (0.7%) ablation procedures, a TVL malfunction occurred within 90 days after catheter ablation. During long‐term follow‐up 9 (4.7%) patients showed lead dislodgement, 2 (1.1%) lead fracture, and 2 (1.1%) lead insulation defect not related to the ablation procedure. Conclusion Our findings using CARM demonstrate long‐term efficacy and safety of radiofrequency catheter ablation of AF in patients with CIED and TVL.

Long‐term risk of cardiovascular implantable electronic device–related infection after catheter ablation of arrhythmia

“…Current data on the long-term influence of catheter ablation (CA) of atrial fibrillation and other arrhythmias on cardiovascular implantable electronic devices (CIEDs) indicate relative safety of these procedures, especially outside the critical periprocedural period. [1][2][3][4] Less is known about a potential risk of CIED-related infections in patients undergoing CA. Contrary to a number of clinical and technical variables, CA is not considered a risk factor of CIED-related infection, although there is little to no data on this subject.…”

Atrial fibrillation ablation in patients with transvenous devices: Safety and insights into getting rid of the 30‐second rule defining procedural success

“…In this issue of the Journal of Cardiovascular Electrophysiology, Dinshaw et al provide both short‐term and long‐term follow‐up of 190 patients with implantable cardiac devices and transvenous leads undergoing radiofrequency ablation for AF. This represented 5% of the patients undergoing ablation at their institution.…”

“…A patient will not want, nor is a clinician going to recommend, another ablation just because the patient had a 31‐second episode of an atrial tachyarrhythmia. Remarkably, the study of Dinshaw et al shows that of the 74.6% of patients with paroxysmal AF and 51.9% of those with persistent AF never had any episodes greater than 30 seconds after their AF ablation. Using a definition up to a 1% AF burden as a successful ablation permitted 89.8% of paroxysmal AF patients and 59.3% of persistent AF patients to be considered a clinical success.…”

“…We must not get too complacent with performing AF ablations in patients with implanted electronic devices. Now that Dinshaw et al have shown that it is safe to perform ablation in patients with traditional devices and transvenous leads, we are entering a new era with different types of devices. These include leadless single‐chamber and ultimately dual‐chamber pacemakers, leadless pacemakers that can communicate with subcutaneous implantable cardioverter defibrillators, and endocardial ultrasonic crystals to facilitate biventricular pacing in patients with a traditional transvenous pacing device .…”

Long‐term risk of cardiovascular implantable electronic device‐related infection after catheter ablation of atrial fibrillation

“…We want to thank Farkowski et al for the insightful comments on our paper in which we assessed the long‐term efficacy and safety of radiofrequency catheter ablation (CA) of atrial fibrillation in patients with cardiac implantable devices (CIEDs) and transvenous leads (TVLs) . The authors bring up the potential risk of CIED‐related infections in patients undergoing CA.…”