Follow-Up after lasso-guided irrigated tip radiofrequency catheter ablation in paroxysmal and persistent atrial fibrillation

Abstract

aims We evaluated clinical outcome of segmental/circumferential pulmonary vein (PV) isolation and linear defragmentation procedure in our first series of patients with paroxysmal or persistent atrial fibrillation (PAF/PEAF). The freedom from symptomatic AF/flutter/ tachycardia recurrences with patients off antiarrhythmic treatment (AAD) was primary endpoint of the procedure. methods Consecutive patients with highly symptomatic PAF/PEAF and AAD failure were prospectively recruited from September 2003 to June 2007. Patients < 70 years with left ventricular ejection fraction > 40 % and left atrial diameter < 50mm were included. During the first procedure 2–4 PVs, non-PV foci, and/or flutter isthmus (FI) were targeted. If arrhythmia recurred, conducting gaps toPVs and FI are ablated after blanking period of > 3 months. In patients with PEAF, fast fragmented/complex electrograms were ablated in a linear fashion, connecting upper PV ostia and/or PV ostia with proximal anatomical structures. Only FI line was tested for completeness of block. The irrigated-tip radiofrequency ablation catheter and Lasso catheter (Biosense-Webster) were used after standard transseptal approach with X-ray fluoroscopy guidance. The suspected arrhythmia recurrences were evaluated by series of ECG/Holter recordings. Results. Fifty-eight patients, 43 men, average age 50 years, range 19–69, including 24(41 %) with PEAF, were enrolled. In these patients, 113 procedures were performed: single study in 20, 2 in 24, 3 in 11, and 4 in 3 patients, respectively. Complications occurred in 5 patients including tamponade in 2, acute effusion in 1, and inadvertened pericardial punction in 2. No PV stenosis, esophageal injury, or stroke were detected clinically during 16-month (4–47) follow-up. We achieved primary endpoint in 42 patients (72 %); partial endpoint in 5 patients (9 %) with significant reduction of AF/flutter/tachycardia recurrences on AAD; and in 11 patients (19 %) procedure was not successful. Overall, 81 % of our patients (93 % with PAF, 63 % with PEAF) benefited from the procedure. conclusions Lasso-guided irrigated-tip RF PV isolation and linear defragmentation is safe and long-term successful treatment of PAF/PEAF in majority of middle-aged patients.