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Long Term outcomes of percutaneous atrial fibrillation ablation in patients with continuous monitoring
Author(s) -
Sulke Neil,
Dulai Rajdip,
Freemantle Nick,
Sugihara Conn,
Podd Steven,
Eysenck William,
Lewis Michael,
Hyde Jonathan,
Veasey Rick A,
Furniss Stephen S
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14282
Subject(s) - medicine , ablation , interquartile range , atrial fibrillation , cryoablation , catheter ablation , cardiology , ablation of atrial fibrillation , pulmonary vein , radiofrequency ablation , percutaneous , atrial tachycardia , surgery
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.