Vnitr Lek 2005, 51(9):971-983

Treatment of symptomatic intermitent atrial fibrillation with catheter ablation in the left atrium: Immediate and long-term results in 150 patients

M. Fiala^1,2,*, J. Chovančík¹, P. Heinc², R. Neuwirth¹, I. Nykl¹, R. Nevřalová¹, M. Branny¹

¹ Kardiocentrum Nemocnice Podlesí, Třinec, přednosta prim MUDr. Marian Branny

² I. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Jan Lukl, CSc.

Catheter ablation has been establishing as a routine curative method of atrial fibrillation. Immediate and long-term results of catheter ablation employing method of pulmonary vein isolation using conventional or electroanatomic mapping in patients with intermitent atrial firillation are presented.

Patients and methods: Ablation was performed in 150 patients (26 females), aged 52.4 ± 10.7 years, in 173 procedures.

Results: During the initial ablation procedure in the first 110 patients, full pulmonary vein isolation was achieved in 358 (96%) of 372 target pulmonary veins. In 286 (77%) out of these 372 pulmonary veins, investigated angiografically before and after the isolation, mean narrowing from 12.6 ± 2.7 to 12.1 ± 2.8 mm was measured. Asymptomatic ostial narrowing, ranging between 25 to 50%, occurred in 16 (5.6%) of pulmonary veins. In the subsequent 40 patients, full isolation was achieved in all 160 pulmonary veins, and in none of them ostial stenosis and turbulent flow were found one month after the ablation during transesophageal echocardiographic examination. Twenty-two patients (15%) underwent a second and one patient a third ablation. Complication (embolic stroke resulting in hemianopsia) occurred in one (0.06%) out of 173 procedures. The mean follow-up period was 15.9 ± 10.3 months. First 110 patients had the folow-up period of 9-40 months and the following 40 patients had follow-up period of 1-6 month after ablation. Among the first 110 patients, 77%, 82%, 83%, 83%, 86%, resp. 89% patients were free of atrial fibrillation at 3^rd, 6^th, 9^th, 12^th and 18^th month after ablation and the clinical benefit, ie. elimination of clinically significant atrial fibrillation was achieved in 85%, 89%, 91%, 93%, 92%, resp. 89% of the patients. In the last 40 patients, elimination of atrial fibrillation and clinical benefit at months 3 and 6 were achieved in 91% resp. 100% patients. Ablation was associated with a significant reduction of antiarhythmic and anticoagulation medication.

Conclusion: Catheter ablation of intermitent atrial fibrillation in patients without major structural heart disease, based on full isolation of all pulmonary veins, is highly effective and relatively safe. Although technology and ablation strategies continuously evolve, ablation of atrial fibrillation can be currently considered a routine curative method.

Keywords: intermitent atrial fibrillation; catheter ablation; pulmonary vein isolation

Received: October 21, 2004; Accepted: February 3, 2005; Published: September 1, 2005  Show citation