Sicherheit und Effizienz der Pulmonalvenenablation nach Start eines neuen Ablationsprogramms zur Behandlung von Patienten mit symptomatischem Vorhofflimmern

Abstract

Introduction: Pulmonary vein (PV) ablation is an established treatment for atrial fibrillation (AF). Due to its high prevalence the number of ablation centers needs to be increased. Initiating a PV ablation program remains a challenge due to the complexity of PV ablation and its risk for life-threatening complications. Aim of this prospective study was to evaluate the procedural safety and efficacy after initiation of a new PV ablation program with operators inexperienced in PV ablation. Methods and Results: From 2006 to 2011, 331 consecutive patients underwent 500 CARTO guided circumferential PV ablation utilizing an irrigated tip catheter. Follow up for symptomatic AF was 648±315 days. Procedure times of PV ablation and X-ray applied were inversely correlated with experience. Major complications occurred in 4 %, and more so in the early procedures. After the first 100 ablations the incidence of major complications reached 1,3 - 1,9%. There were no deaths, nor complications with permanent health impairment. Freedom from symptomatic AF recurrences was noted in 81,3 % of patients (226 / 327) after 1.6±0.7 PV ablation procedures independent from experience during one year follow-up. Conclusions: Initiating a new PVA program is associated with increased complication rates. After 100 cases the complication rate reaches a level in line with the literature. Success rates in the earlier cases appear similar, however with longer procedure times and fluoroscopy times. Enlarged left atrial diameter and early recurrences of atrial fibrillation in the blanking period were found to be independent predictors for recurrence of atrial fibrillation after ablation. Reablation procedures improve significantly the long-term success rate. These data could be useful planning a new PV ablation program.