Two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus radiofrequency ablation vs pharmacological only antiarrhythmic therapy: a single center experience

Abstract

The benefit of radiofrequency ablation (RFA) in rhythm control in atrial fibrillation (AF) and flutter patients is uncertain, but risk of death, arrhythmia recurrence and other post ablation complications remains high. Existing data on the impact of pulmonary vein isolation and cava-tricuspid isthmus RFA on long-term prognosis of patients with AF and flutter and its advantage over pharmacological antiarrhythmic therapy (AAT) are insufficient and contradictory.
 The aim: we sought to evaluate two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus RFA vs pharmacological only AAT according to a single center experience.
 Material and methods: we enrolled 174 patients after pulmonary vein isolation RFA, cava-tricuspid isthmus RFA and their combination and 122 patient who did not undergo RFA and got pharmacological AAT only.
 Results: there was no significant difference in mortality between the RFA and AAT only groups (5.8 % and 9.0 % respectively) with the same structure of causes of death. The Caplan-Meyer curve analysis demonstrated better survivance (p=0.031) after RFA just during first year of observation. RFA effectiveness in arrhythmia relapse prevention was the highest for cava-tricuspid isthmus RFA procedure and worst – in group of combined pulmonary vein isolation and cava-tricuspid isthmus procedures. RFA showed an advantage over AAT in smaller quantities of non-fatal cardiovascular events (p<0.001) and cardiovascular hospitalizations (p=0.0026).
 Conclusions: RFA of pulmonary vein isolation and cava-tricuspid isthmus RFA decrease arrhythmia episodes frequency, risk of non-fatal cardiovascular events and cardiovascular hospitalizations. Timely combined PVI and CTI procedure is associated with worsening of all outcomes.