Long Term outcomes of percutaneous atrial fibrillation ablation in patients with continuous monitoring

Abstract

Introduction: There is limited data using continuous monitoring to assess outcomes of atrial fibrillation (AF) ablation. This study assessed long‐term outcomes of AF ablation in patients with implantable cardiac devices. Methods: 207 patients (mean age 68.1 ± 9.5, 50.3% men) undergoing ablation for symptomatic AF were followed up for a mean period of 924.5 ± 636.7 days. Techniques included The Pulmonary Vein Ablation Catheter (PVAC) (59.4%), cryoablation (17.4%), point by point (14.0%) and The Novel Irrigated Multipolar Radiofrequency Ablation Catheter (nMARQ) (9.2%). Results: 130 (62.8%) patients had paroxysmal AF (PAF) and 77 (37.2%) persistent AF. First ablation and repeat ablation reduced AF burden significantly (relative risk 0.91, [95% CI 0.89 to 0.94]; P <0.0001 and 0.90, [95% CI, 0.86–0.94]; P <0.0001). Median AF burden in PAF patients reduced from 1.05% (interquartile range [IQR], 0.1%‐8.70%) to 0.10% ([IQR], 0%‐2.28%) at one year and this was maintained out to four‐years. Persistent AF burden reduced from 99.9% ([IQR], 51.53%‐100%) to 0.30% ([IQR], 0%‐77.25%) at one year increasing to 87.3% ([IQR], 4.25%‐100%) after four years. If a second ablation was required, point‐by‐point ablation achieved greater reduction in AF burden (relative risk, 0.77 [95% CI, 0.65–0.91]; P <0.01). Conclusion: Ablation reduces AF burden both acutely and in the long‐term. If a second ablation was required the point‐by‐point technique achieved greater reductions in AF burden than “single‐shot” technologies. Persistent AF burden increased to near pre ablation levels by year 4 suggesting a different mechanism from PAF patients where this increase did not occur.

Rate or Rhythm Control in CRT (RHYTHMIC): Study rationale and protocol

“…In a recent study of 207 patients with AF J o u r n a l P r e -p r o o f and existing pacemakers, ICDs or implantable loop recorders, AF ablation significantly reduced the burden of AF in patients with both paroxysmal and persistent AF at 1 year follow-up (median AF burden 1.05% vs 0.10% and 99.9% vs 0.30% respectively). 33 Significant reductions compared to pre-ablation were also found at 4 year follow-up (0.10% and 87.3% respectively). In the context of patients with heart failure, persistent AF and CRT, while longterm sinus rhythm maintenance may be difficult to achieve, a reduction in AF burden may be sufficient to achieve a benefit due to improved biventricular pacing and atrioventricular synchrony.…”

A retrospective analysis of frailty status on atrial fibrillation catheter ablation outcomes

“…All patients undergoing first‐time PVI at our institution undergo cryoablation (28‐mm Arctic Front Advance). The procedural method and technique employed by our group have previously been described in detail 11,12 . Briefly, after transseptal access had been achieved, the cryoballoon catheter and sheath were delivered to the left atrium.…”

“…The procedural method and technique employed by our group have previously been described in detail. 11,12 Briefly, after transseptal access had been achieved, the cryoballoon catheter and sheath were delivered to the left atrium.…”