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DOI: 10.1055/s-0034-1367442
12-months late procedural success after ablation of atrial fibrillation correlates with energy source and patient characteristics
Objectives: Nowadays freedom from atrial fibrillation (Afib) is considered as protective regarding congestive heart failure, stroke and reduction of quality of life. Although procedural advance is taken to reach freedom from atrial fibrillation therapeutical success still depends on patient's individual characteristics and risk factors but on the other hand as well on surgical strategy. Here we investigated the chance of success to reach freedom from atrial fibrillation depending on patient-characteristics and surgical ablation system.
Methods: We initiated a prospective all comers-study. Patients underwent pre- and postoperative monitoring and standardized left-atrial ablation (paroxysmal Afib) or bi-atrial ablation (persistent/long standing persistent Afib) with bipolar radiofrequency. We used either the MedtronicCardioblate© (MC) device or the Estech Cobra Revolution© (ECR) system as specified by the individual manufacturer. An event recorder (ER) was implanted in all patients. Left and right atrial appendices were removed and cryo-conserved together with serum samples. We provided standardized in-department ambulance service for follow-up monitoring at intervals of 6 month (ER-readout, ECG, TTE, serology).
Results: 105 patients underwent ablation (31 paroxysmal; 74 persistent Afib). Overall 30-day mortality was 6/105, without correlation to Afib type, Afib duration, echo parameters, age. Female sex and high Euro-Score correlated with mortality. In all patients freedom from atrial fibrillation was reached in 72% of patients after 6 months and in 64% of patients after 12 months. Freedom from stroke was ubiquitous. Left-atrial-diameter, body mass index (BMI>33) and disturbance in adipokine balance (low adiponectin, high leptin) correlated to Afib persistence. We observed recurrence of paroxysmal Afib in only 1/31 patients (MC treatment), who underwent successful catheter ablation after 3 months resulting in a 100% freedom from Afib after 12 months in paroxysmal fibrillation. In persistent Afib only 19% of MC-treated but 82% of ECR-treated patients reached freedom from Afib after 12 months.
Conclusions: Therapeutical success can be estimated by patient characteristics as LA diameter, LV ejection fraction and BMI. Even when used as specified by the manufacturer, the available devices differ regarding long-term success. Temperature-controlled bipolar radiofrequency showed therapeutical advantages in our study.