Ablación por radiofrecuencia para el tratamiento de la fibrilación auricular focal a través de cartografía circunferencial y aislamiento segmentario de las venas pulmonares

Abstract

The treatment of paroxysmal atrial fibrillation in patients without structural heart disease using radiofrequency ablation of pulmonary veins is a recently developed procedure with a good clinical success rate, although there have only been a few published series. We analyzed our results with this technique. The procedure was performed in 33 highly symptomatic patients with focal atrial fibrillation that had probably originated in the pulmonary veins. The electrophysiological study was carried out with a decapolar catheter inserted by transeptal catheterization. Ablation was performed using a 4-mm catheter and directed to the segments of the ostium of pulmonary veins where venous potentials with greatest precocity were recorded. Subsequent radiofrecuency applications were performed until pulmonary vein disconnection was achieved. Venous electrical activity was recorded in 59 of 115 pulmonary veins that were mapped (58 were disconnected). During a median follow-up of 180 days, 8 patients recurred and only 2 of these continue with repeat episodes. The success rate at short term was 74.2% and at mid-term was 93.5%. Nineteen patients continue to receive antiarrhythmic treatment innefective before the procedure. Two patients showed complications related to catheter manipulation during tansseptal catheterization, probably due to air embolism, that was resolved spontaneously without consequences. No patient showed pulmonary stenosis. Teatment of focal atrial fibrillation using circumferential mapping and radiofrecuency application in segments of the ostium of pulmonary veins is a highly effective procedure in selected patients and has potentially severe although infrequent complications.