Catheter ablation of permanent atrial fibrillation: medium term results

Mark J Earley ¹, Dominic J Abrams ², Andrew D Staniforth ¹, Simon C Sporton ¹ and Richard J Schilling ^1*

¹ St Bartholomew's Hospital, United Kingdom
² St. Bartholomew's Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: r.schilling{at}qmul.ac.uk.

Accepted 22 July 2005

Abstract

Objective: To investigate the feasibility of catheter ablation as a treatment for symptomatic patients with longstanding permanent atrial fibrillation (AF).

Methods: Radiofrequency ablation was applied to encircle all pulmonary veins (PVs) and create lines from the left inferior PV to mitral valve, along the roof of the left atrium between the PVs, and along the tricuspid valve-inferior vena cava isthmus. A 7 day Holter recording was performed at discharge and at follow up to assess arrhythmia burden. If patients developed a symptomatic, sustained atrial arrhythmia a repeat ablation procedure was advised.

Results: 42 patients underwent the procedure that took a mean of 5 hours with 50 minutes fluoroscopy. After a median follow up of 8.4 months 31/41 surviving patients (76%) were in sinus rhythm. Of these, 29 patients were off all antiarrhythmic drugs but 22 (52%) required more than one procedure. During follow up 49% experienced a sustained atrial tachycardia. 26 repeat procedures were performed and the maintenance of sinus rhythm after the first, second or third procedure was 36% (15/42), 58% (11/19) and 71% (5/7) respectively. From a total of 68 procedures there were 2 serious complications (2.9%): a stroke from which a full recovery was made and a PV stenosis.

Conclusion: Catheter ablation can be used to cure longstanding permanent AF, however, there is a significant complication rate. Whether this is offset by a mortality benefit associated with sinus rhythm is unknown. Many patients will need more than one procedure in order to achieve a success.

Keywords: atrial fibrillation, catheter ablation

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