Introduction The practice of atrial fibrillation (AF) ablation is increasing exponentially. At present, these procedures are performed in a small number of surgical tertiary centres. In order to meet the growing demand it will be necessary to expand this service. We sought to assess patient satisfaction, procedural success and complication rates for AF ablation performed via a newly established district general hospital (DGH) service.
Methods We prospectively surveyed patients undergoing AF ablation, between November 2007 and November 2010, at Eastbourne DGH. Patient symptoms were assessed before and at least 12 months after AF ablation by telephone questionnaire, procedural satisfaction was also assessed. Procedural details (procedural time, fluoroscopy time, ablation technique) and complications were all accurately recorded for every case.
Results In 278 patients 314 procedures (average 1.13 procedures/pt) were performed (160 for persistent AF [PersAF], 134 for paroxysmal AF [PAF]). Mean age 63.8±10.7 years, 70% male. Of the PAF cases 75 procedures were performed with the PVAC (Medtronic, USA) and 56 with the Mesh (Bard, USA) catheter. The remaining three PAF procedures were performed with LASSO, Artic front cyroablation balloon and the Amigo robot (Catheter Robotics, Inc.) and weren't used in the analysis. Mean procedural time was 107.9±35.9 min, fluroscopy time was 32.1±11.3 min. Both measures were significantly shorter in the PVAC PAF group (p<0.001 for both). Mean hospital stay was 0.84±0.6 bed days. Mean follow-up time was 529±187.54 days. Subjective freedom from AF recurrence for all cases was 61%; for PAF PVAC 80% (p<0.05), for PAF Mesh 54% and for PersAF 59%. 76% reported some symptom improvement. 86% of patients were highly satisfied with the procedure. Major complications included: stroke in three patients (0.95%), TIA in 1 patient (0.32%), pericardial tamponade in four patients (1.27%), significant pulmonary vein stenosis in one patient (0.32%) and phrenic nerve palsy in two patients (0.64%).
Conclusion Our 3 year experience shows that AF ablation can be safely performed in a DGH settings with high procedural success rates and low complication rates. There was no need for acute surgical intervention in any of our cases.
- Atrial fibrillation
- district general hospital