Pulmonary vein ablation for idiopathic atrial fibrillation: six month outcome of first procedure in 100 consecutive patients

Abstract

Objectives: To report six month outcome in patients undergoing their first pulmonary vein ablation procedure for idiopathic atrial fibrillation (AF) at a ''non-pioneering'' hospital. Design: Prospective observational study. Setting: Specialist electrophysiology unit at a university hospital. Patients: The first 100 consecutive patients undergoing their first pulmonary vein catheter ablation procedure for highly symptomatic, drug resistant AF in the period 1999-2002. Main outcome measures: Incidence of symptomatic or asymptomatic, Holter documented AF six months after ablation. Results: Mean patient age was 52 years (range 23-73 years), mean length of AF history 53 months (range 6-180 months), mean number of antiarrhythmic drug failures was 3 (range 1-5), and 81 were men. At the time of the ablation procedure, 64 had progressed to persistent AF and 23 had increased transverse left atrial diameter. The number of pulmonary veins ablated in each patient was one in 11, two in 45, three in 36, and four in 8. Six months after ablation, 55 patients were consistently in sinus rhythm, asymptomatic, and without any Holter evidence of AF. The chance of being in sinus rhythm was 73% (29 of 64) in those with paroxysmal as compared with only 45% (26 of 36) in those with persistent AF at the time of ablation (p = 0.01). Outcome was not influenced by patient age, length of AF history, or duration of persistent AF before ablation or to left atrial dimension. Follow up was complete and no patient has died or experienced a stroke during or after ablation; nor have any developed symptoms of late pulmonary vein stenosis. However, other complications occurred during or shortly after the procedure in 12 patients, including cardiac tamponade in six. Conclusions: In selected patients with drug resistant AF, focal pulmonary vein catheter ablation offers a realistic prospect of achieving stable sinus rhythm compared with alternatives. However, it is a complex form of ablation with a significant risk of serious complications. Although a new milestone in arrhythmia management, the optimum ablation technique is still evolving and any impact on the natural history of AF remains to be determined.

ST-segment elevation induced during the transseptal procedure for radiofrequency catheter ablation of atrial fibrillation

“…The transseptal (Brockenbrough's) puncture is widely utilized to access left atrium for this purpose. Known complications of the transseptal RF ablation include aortic root and atrial perforation, stroke, transient ischemic attacks, pericardial effusion, pulmonary vein stenosis, and atrio-esophageal fistula formation [2,3]. The present report describes two cases of coronary artery ischemia induced during the transseptal puncture for RF ablation of atrial fibrillation.…”

Atrial fibrillation ablation in the real world

“…Another recent report in Heart from a ''nonpioneering'' centre reported 55% success at six month follow up following a first procedure, in a consecutive series of 100 patients. 12 Cardiac tamponade requiring pericardiocentesis occurred in six patients, right coronary artery embolus in two, and complete heart block in one. Again, the technique evolved during the study, from targeting only arrhythmogenic veins, to attempting to isolate all four pulmonary veins, and the addition of linear lesions in the atrium.…”

Evaluating the Cost-effectiveness of Catheter Ablation of Atrial Fibrillation

“…31,32,39 Unlike the previous analysis, the comparator to catheter ablation was AAD, and ablation was treated as second-line therapy for patients failing AAD. For a predominantly male (80 %), younger (mean age 52 years) patient population with CHADS 2 score of 1, the study yielded an ICER of £25,510/QALY over a five-year time horizon and an ICER of £7,780/ QALY over a lifetime horizon.…”