Study On The Safety And Effectiveness Of Radiofrequency Ablation Strategies For Atrial Fibrillation

Section ?:Safety and efficacy of FASS strategy on atrial fibrillation radiofrequency ablation:results of 536 casesIntroduction:This study aimed to evaluate the safety and efficacy of an optimized atrial fibrillation(AF)radiofrequency catheter ablation(RFCA)strategy in real world.Methods:Fast anatomic mapping and contact force sensing ablation was applied on AF ablation between September 2014 to September 2016 with single trans-septal sheath.Pulmonary vein isolation(PVI)and linear ablation were performed in paroxysmal AF(PAF)and persistent AF(PeAF)individually with 10-20g contact force with minimal fluoroscopy.Stimulation with 10 mA outputs on the lesions without capture was used as endpoint.Results:There were 536(375 PAF and 161 PeAF)consecutive first-time RFCA patients enrolled.Acute PVI was achieved in all PAF patients.AF termination by ablation was achieved in 110(68.3%)of PeAF patients.The average procedure time was 74.7 ± 10.0 min.in PAF and 85.4 ± 8.7 min.in PeAF,with an average of 27.2 ± 8.0 min.ablation time in PAF and 33.4 ±9.6 min.in PeAF.The average radiation dose was 24.3 ± 25.2 mGy.At a mean follow-up time of 14.1 ± 4.7 months,sinus rhythm was maintained in 85.0%in PAF and 60.2%in PeAF.Tamponade occurred in 2 cases.Conclusion:Contact force sensing provides a safe AF ablation mode with low radiation.A 10-20g contact force is a sufficient and safe setting.Section ?:Ascending Aortic Injury post Radiofrequency Catheter Ablation for Atrial FibrillationIntroduction:The ascending aorta(AAO)injury adjacent to left atrium(LA)during radiofrequency catheter ablation(RFCA)for atrial fibrillation(AF)remains unknown.This study aimed to estimate the AAO injury post AF ablation.Methods:From June 2008 and January 2018,there were 220 AF patients who underwent the first-time of RFCA for AF and accepted echocardiology and multi-detector computed tomography(MDCT)examination during follow up enrolled.Results:At a mean follow up time of 24.1±23.5 months,AAO dilatation was presented in 112 patients(50.9%)measured by echocardiology and in 128(58.2%)by MDCT.AAO dilatation?3mm were observed in 39(17.7%)by echocardiology and in 20(9.1%)by MDCT.Significant AAO dilatation was observed both in echocardiology(1.0±3.3 mm,P<0.01)and MDCT(0.6±1.8 mm,P<0.01).Extremely,trans-septal puncture failure occurred in one case because of AAO dilatation during the redo procedure.Cox regression analysis showed that AAO dilatation post-ablation was associated with pre-ablation AAO diameter?35mm(OR 3.546,95%CI 1.370-9.174,P = 0.009)and the application of contacted force sensing ablation catheter(OR 4.001,95%CI 2.158-7.419,P<0.001).Linear correlation analysis indicated that AAO dilatation extent was associated with aortic-LA distance(r = 0.144,P = 0.040)and follow-up time(r = 0.202,P = 0.003).Conclusion:RFCA for AF may produce AAO injury.Appropriate ablation strategies and early screening especially in certain patients is necessary.Section ?:Safety and efficacy on atrial fibrillation radiofrequency ablation in young patientsIntroduction:The outcome data of atrial fibrillation(AF)radiofrequency catheter ablation(RFCA)in young patients was scarce.This study aimed to evaluate the safety and efficacy of AF ablation in young patients.Methods:Patients with age less than 45 years was enrolled matched with elder patients between January 2013 to April 2017.Anatomic and substrate mapping was applied.Pulmonary vein isolation(PVI)and linear ablation were performed in paroxysmal AF(PAF)and persistent AF(PeAF)individually.Follow-up including complications and atrial arrhythmias recurrence were evaluated.Results:There were both 205(147 PAF and 58 PeAF)consecutive first-time RFCA patients enrolled in young and elder patients group.Low voltage zones(LVZ)were found in 16 young patients and 21 elder patients vs 16(P=0.499),while the LVZ were more found in young patients than the elder with PeAF(LVZ:11 vs 3,P=0.023;local LVZ:1 vs 0,P=0.315;extensive LVZ:10 vs 3,P=0.039).At a mean follow-up time of 27.5±15.3 months,sinus rhythm was maintained in 61.0%(67.3%in PAF and 44.8%in PeAF)in young patients and 74.6%(80.3%in PAF and 60.3%in PeAF)in elder patients.In young patients,tamponade occurred in 1 cases(0.5%).In elder patients,tamponade occurred in 2 cases(1.0%).Cox regression analysis showed that ablation success was associated with PAF(OR 0.464,95%CI 0.268-0.803,P = 0.006)and contact force sensing catheter application(OR 0.487,95%Cl 0.286-0.829,P =0.008).Conclusion:Compared with elder patients,the RFCA in young patients gets satisfactory safety without ideal efficacy.The application of contact force sensing catheter may improve the success rate.