Abstract
ObjectiveTo assess the outcome and associated risks of atrial defragmentation for the treatment of long-standing persistent atrial fibrillation (LSP-AF).MethodsThirty-seven consecutive patients (60.4 ± 7.3 years; 28 male) suffering from LSP-AF who underwent pulmonary vein isolation (PVI) and linear ablation were compared. All patients were treated with the Stereotaxis magnetic navigation system (MNS). Two groups were distinguished: patients with (n = 20) and without (n = 17) defragmentation. The primary endpoint of the study was freedom of AF after 12 months. Secondary endpoints were AF termination, procedure time, fluoroscopy time and procedural complications. Complications were divided into two groups: major (infarction, stroke, major bleeding and tamponade) and minor (fever, pericarditis and inguinal haematoma).ResultsNo difference was seen in freedom of AF between the defragmentation and the non-defragmentation group (56.2 % vs. 40.0 %, P = 0.344). Procedure times in the defragmentation group were longer; no differences in fluoroscopy times were observed. No major complications occurred. A higher number of minor complications occurred in the defragmentation group (45.0 % vs. 5.9 %, P = 0.009). Mean hospital stay was comparable (4.7 ± 2.2 vs. 3.4 ± 0.8 days, P = 0.06).ConclusionOur study suggests that complete defragmentation using MNS is associated with a higher number of minor complications and longer procedure times and thus compromises efficiency without improving efficacy.
Highlights
Catheter ablation in patients with paroxysmal atrial fibrillation (AF) in which the pulmonary veins (PVs) are electrically isolated is a well-accepted treatment and has proven to be successful [1,2,3]
Our study suggests that complete defragmentation using magnetic navigation system (MNS) is associated with a higher number of minor complications and longer procedure times and compromises efficiency without improving efficacy
It remains unclear if a combination of PV isolation (PVI) and complex fractionated atrial electrograms (CFAEs) ablation significantly increases the success rate of long-standing persistent AF (LSP-AF) ablation as opposed to PVI and linear ablation [4, 16]
Summary
Catheter ablation in patients with paroxysmal atrial fibrillation (AF) in which the pulmonary veins (PVs) are electrically isolated is a well-accepted treatment and has proven to be successful [1,2,3]. Additional ablation lines and other techniques have been proposed to increase the success rate of LSP-AF ablation, one of these being atrial defragmentation [12]. During this procedure electrogram-based ablation is performed. The benefit of PVI and additional linear ablation in the treatment of LSP-AF has been shown in several studies [4, 12, 15] It remains unclear if a combination of PVI and CFAE ablation significantly increases the success rate of LSP-AF ablation as opposed to PVI and linear ablation [4, 16]
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