Approaches to Catheter Ablation for Persistent Atrial Fibrillation

Approaches to Catheter Ablation for Persistent Atrial Fibrillation

1. APPROACHES

   • Ablation with pulmonary-vein isolation alone
   • Pulmonary-vein isolation plus ablation of complex fractionated electrograms
   • Pulmonary-vein isoation plus linear ablation

2. CRITERIA

   • INCLUSION
     • Older than 18 yars old
     • They should have symptomatic persistent atrial fibrilation
     • They have to be undergoing ablation for the first time
     • All participating patients provided written informed consent
   • EXCLUSION
     • Paroxysmal atrial fibrilation
     • Sustained atrial fibrilation lasting more than 3 years
     • Left atrial diameter of 60mm or greater

3. PATIENTS WERE RANDOMLY ASSIGNED

   • IN THIS WAY
     • Pulmonary-vein isolation alone
     • Pulmonary-vein isolation plus ablation of compex fractionated electrograms
     • Pulmonary-vein isolation plus linear ablation across the roof of the left atrium and in the mitrial valve ithmus

4. POCEDURES

   • It was used radio diofrequency energy delivered by a catheter with an open, irrigated tip
   • Antigulation was continued after ablation for a minimum of 3 months
   • Before ablation, tratment with antiarrhythmic medications was stopped and patients recived oral anticoagulation for at least 4 weeks

5. CLINICAL ASSESTENTS

   • EKG 12 lead
   • Holter-monitor
   • Trans-telephonic monitor

6. STUDY OUTCOMES

   • freedom from any documented episode of atrial fibrillation lasting longer than 30 seconds and occurring after the performance of a single ablation procedure
   • Main secondary outcomes included freedom from documented atrial fibrillation after two ablation procedures
   • The expected freedom from atrial fibrillation after one ablation procedure was 75% for isolation plus electrograms and 45% for isolation alone.
   • Successful pulmonary-vein isolation was achieved in 97% of all patients, with no significant differences between groups.

7. Adverse Events

   • The most common adverse events were sedation-related complications
   • Arteriovenous fistula or pseudoaneurysm at the access site
   • Hematoma at the access site
   • Fluid overload