Clinical Effect Of Catheter Ablation For Atrial Fibrillation

Background and objectiveAtrial fibrillation (AF) is one of the most common cardiac arrhythmias, which is harmful to human health and quality of life, and can now be treated by radiofrequence catheter ablation. There are several different ways for ablation, such as pulmonary vein isolation (PVI), and three diamensions (3D) electroanatomical system (Carto system and EnSite system) guided CAPV (circumferential antrum ablation of pulmonary veins) and CPVI ( circumferential pulmonary veins isolation). The successful rate and the safety of catheter ablation has increase by guided by electroanatomical system. In our study, we have performed catheter ablation since October 2005. This article can be regarded as an assessment and analysis of catheter ablation for AF.MethodsA cohort of 43 consenting cases at the Southwest Hospital from October 2005 to January 2009 were studied, 29 male and 14 female; the average age was 51.93±13.94 (18~77) years old. Among them there were 32 cases of paroxysmal AF, and 11 cases of persistent AF. 15 cases were complicated with hypertension and 4 were complicated with coronary artherosclerosis. All the 43 cases were suffered from obvious clinical discomfortable symptoms. Pulmonary vein/ superior vena cava isolation was performed in 8 cases (recurrent 1 case) . CPVI was performed in the other 35 cases (recurrent 3 cases) . The endpoint of the ablation was complete electronic isolation of all the pulmonary veins (PVs)/ superior vena cava. For these who aren't isolated PVs completely, the conducted gap was initially posited by the mapping catheter, and the earlist fragmented potential was targeted for ablation till the complete electronic isolation of all the PVs.Results①The immediate and the short-term results of catheter ablation: 43 cases were successfully achieved immediately the endpoint after the ablation. No severe complications such as pulmonary vein stenosis, pericardial tamponade, cardio-esophagus fistula occurred during and after the procedure. The acute successful rate was 100%, while 7 cases were converted to atrial flutter after ablation, and cardioversed to sinus rhythm by electroversion. 11 cases developed atrial tachyarrhythmias in 5 to 7 days after ablation: 6 cases were paroxysmal atrial tachycardias / atrial flutter, 1 of these cases was at junctional escape rhythm with paroxysmal atrial tachycardia, 4 cases were paroxysmal AF, and 1 case was persistent AF which turned to be sinus rhythm by electroversion. 1 case was at sinus bradycardia, sinus arrest and junctional escape rhythm. 41 cases were at sinus rhythm at discharge.②The procedure and safety of catheter ablation: Most AF cases were triggered activity near the PV ostium which drived AF, while 2 cases were triggered activity on left superior vena cava and right superior vena cava respectively. More than half cases underwented circumferential pulmonary veins atrial ablation also created ablation lines in the mitral and tricuspid isthmus. 10 cases performed coronary sinus ablation, 7 cases suffered thoracic discomfort within 48 hours, and 3 cases suffered asymptomatic pericardial effusion after the ablation. All the 43 cases didn't suffer dyspnea,hemoptysis, etc before discharge, and distention of jugular vein, pulsus paradoxus, pericardial rub were not found through physical examination. No severe complication was found during and after the procedure.③Follow-up: 42 cases were followed-up after 3-14 months, average 6±2 months, only 1 case lost communication. 4 cases were early recurrence: 1 case with persistent AF was converted to paroxysmal AF within 3 days after PVI and underwented CPVI successfully after 10 months; 1 case with persistent AF was converted to paroxysmal atrial flutter after CPVI, underwented electrophysiology study and CPVI successfully; 1 case with paroxysmal AF recurrence after CPVI refused re-ablation, decreased episode frequency and took amiodarone to maintain sinus rhythm; another one with paroxysmal AF recurrence paroxysmal atrial tachycardia who was diagnosed cardiomyopathy. All the cases didn't occur dyspnea and cough related to pulmonary vein stenosis. The LAD(left atrial dimension) of 35 cases recovered nomal size (diameter≤35mm) on cardiac ultrasound 3 months after ablation.ConclusionCatheter ablation is safe and effective for treating AF.