Abstract
The benefit of radiofrequency ablation (RFA) in rhythm control in atrial fibrillation (AF) and flutter patients is uncertain, but risk of death, arrhythmia recurrence and other post ablation complications remains high. Existing data on the impact of pulmonary vein isolation and cava-tricuspid isthmus RFA on long-term prognosis of patients with AF and flutter and its advantage over pharmacological antiarrhythmic therapy (AAT) are insufficient and contradictory.
 The aim: we sought to evaluate two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus RFA vs pharmacological only AAT according to a single center experience.
 Material and methods: we enrolled 174 patients after pulmonary vein isolation RFA, cava-tricuspid isthmus RFA and their combination and 122 patient who did not undergo RFA and got pharmacological AAT only.
 Results: there was no significant difference in mortality between the RFA and AAT only groups (5.8 % and 9.0 % respectively) with the same structure of causes of death. The Caplan-Meyer curve analysis demonstrated better survivance (p=0.031) after RFA just during first year of observation. RFA effectiveness in arrhythmia relapse prevention was the highest for cava-tricuspid isthmus RFA procedure and worst – in group of combined pulmonary vein isolation and cava-tricuspid isthmus procedures. RFA showed an advantage over AAT in smaller quantities of non-fatal cardiovascular events (p<0.001) and cardiovascular hospitalizations (p=0.0026).
 Conclusions: RFA of pulmonary vein isolation and cava-tricuspid isthmus RFA decrease arrhythmia episodes frequency, risk of non-fatal cardiovascular events and cardiovascular hospitalizations. Timely combined PVI and CTI procedure is associated with worsening of all outcomes.
Highlights
Radiofrequency ablation (RFA) is one of the leading approaches to rhythm control in atrial re-entry arrhythmias
There was no difference in age, gender, body mass index (BMI), presence of hypertension and congestive heart failure (CHF) in Groups 1-3 and between RFA and control group (Table 1)
Results from this study demonstrated no significant difference in all-cause mortality level between RFA and antiarrhythmic therapy (AAT) only strategies (8.6 % vs 9.0 %) for rhythm control in patients with atrial fibrillation (AF) within a two-year period, which is close to the CABANA study report [4, 11] (8.0 % vs. 9.2 %), it included older patients or patients with risk factors for stroke
Summary
Radiofrequency ablation (RFA) is one of the leading approaches to rhythm control in atrial re-entry arrhythmias It is a first-choice treatment tactic in symptomatic and high-risk atrial flutter and often prescribed to atrial fibrillation (AF) patients with drug inefficiency or intolerance [1, 2]. Researches show ablation preference in arrhythmia relapse prevention, but the level of post ablation AF and flutter recurrence remains from 40 to 60 % according to various sources [5, 6]. Most of these cases needed repeated RFA procedures. Data on all-cause mortality levels and general survivance are comparable for RFA and AAT only treatment [7, 8]
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