Comparison of catheter ablation and surgical ablation in patients with long-standing persistent atrial fibrillation and rheumatic heart disease: a four-year follow-up study.

Abstract

BACKGROUND:

In our previous prospective and randomized study, we have demonstrated that the concomitant surgical ablation using saline-irrigated cooled tip radiofrequency ablation (SICTRA) system is more effective than subsequent circumferential pulmonary vein isolation (CPVI) combined with substrate modification in treating patients with long-standing persistent atrial fibrillation (LS-AF) and rheumatic heart disease (RHD) undergoing cardiac surgery during middle-term follow-up. Whether this strategy also decreases longer-term arrhythmia recurrence is unknown. This study describes the 4-year efficacy of SICTRA for these patients. Furthermore, we seek to compare the electrophysiological characteristics for recurrent atrial tachyarrhythmia (ATa) at the session of catheter ablation between two groups.

METHODS:

Long-term follow-up was performed in 95 patients who underwent the catheter ablation strategy (n=47, Group A) or SICTRA (n=48, Group B) combined with valvular surgery for symptomatic LS-AF patients with RHD.

RESULTS:

After one procedure, Group B had a significantly higher freedom from ATa compared with Group A (29/48 vs 15/47, P=0.005) after a mean follow-up of 54 months (range 48 to 63 months). Catheter-based mapping and ablation of recurrent ATa showed larger amounts of macro-reentrant atrial tachycardias (ATs) in Group B and higher incidence of pulmonary vein (PV) recovery in Group A. After multiple catheter ablations for recurrent ATa, sinus rhythm (SR) could be maintained equally between two groups.

CONCLUSIONS:

Single procedure success seems to be higher with SICTRA but repeated catheter ablation potentially results in comparable outcomes in treating patients with LS-AF and RHD during long-term follow-up. More macro-reentrant ATs and more PV recoveries are identified to be responsible for ATa in SICTRA and catheter ablation group, respectively.

• Authors: Jun Gu, Xu Liu, Wei-feng Jiang, Feng Li, Liang Zhao, Li Zhou, Yuan-long Wang, Yu-gang Liu, Xiao-dong Zhang, Shao-hui Wu, Kai Xu, Dao-liang Zhang, Jia-ning Gu
• Journal: International journal of cardiology (Int J Cardiol) Vol. 168 Issue 6 Pg. 5372-7 (Oct 15 2013) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 24016546 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: © 2013.

Topics

• Adult
• Aged
• Atrial Fibrillation (physiopathology, surgery)
• Cardiac Electrophysiology
• Cardiac Surgical Procedures
• Catheter Ablation
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Prospective Studies
• Pulmonary Veins (surgery)
• Recurrence
• Rheumatic Heart Disease (physiopathology, surgery)
• Sternotomy
• Treatment Outcome