Outcomes of convergent atrial fibrillation ablation with continuous rhythm monitoring.

Autor: Larson J; Emory University School of Medicine, Atlanta, Georgia., Merchant FM; Emory University School of Medicine, Atlanta, Georgia.; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia., Patel A; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia., Ndubisi NM; Emory University School of Medicine, Atlanta, Georgia.; Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia., Patel AM; Emory University School of Medicine, Atlanta, Georgia.; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia., DeLurgio DB; Emory University School of Medicine, Atlanta, Georgia.; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia., Lloyd MS; Emory University School of Medicine, Atlanta, Georgia.; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia., El-Chami MF; Emory University School of Medicine, Atlanta, Georgia.; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia., Leon AR; Emory University School of Medicine, Atlanta, Georgia.; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia., Hoskins MH; Department of Cardiology, New Mexico Heart Institute, Albuquerque, New Mexico., Keeling WB; Emory University School of Medicine, Atlanta, Georgia.; Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia., Halkos ME; Emory University School of Medicine, Atlanta, Georgia.; Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia., Lattouf OM; Emory University School of Medicine, Atlanta, Georgia.; Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia., Westerman S; Emory University School of Medicine, Atlanta, Georgia.; Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2020 Jun; Vol. 31 (6), pp. 1270-1276. Date of Electronic Publication: 2020 Apr 06.
DOI: 10.1111/jce.14454
Abstrakt: Background: Outcomes of catheter ablation for persistent atrial fibrillation (PeAF) are suboptimal. The convergent procedure (CP) may offer improved efficacy by combining endocardial and epicardial ablation.
Methods: We reviewed 113 consecutive patients undergoing the CP at our institution. The cohort was divided into two groups based on the presence (n = 92) or absence (n = 21) of continuous rhythm monitoring (CM) following the CP. Outcomes were reported in two ways. First, using a conventional definition of any atrial fibrillation/atrial tachycardia (AF/AT) recurrence lasting >30 seconds, after a 90 day blanking period. Second, by determining AF/AT burden at relevant time points in the group with CM.
Results: Across the entire cohort, 88% had either persistent or long-standing persistent AF, mean duration of AF diagnosis before the CP was 5.1 ± 4.6 years, 45% had undergone at least one prior AF ablation, 31% had impaired left ventricle ejection fraction and 62% met criteria for moderate or severe left atrial enlargement. Mean duration of follow-up after the CP was 501 ± 355 days. In the entire cohort, survival free from any AF/AT episode >30 seconds at 12 months after the blanking period was 53%. However, among those in the CM group who experienced recurrences, mean burden of AF/AT was generally very low (<5%) and remained stable over the duration of follow-up. Ten patients (9%) required elective cardioversion outside the 90 day blanking period, 11 patients (9.7%) underwent repeat ablation at a mean of 229 ± 178 days post-CP and 64% were off AADs at the last follow-up. Procedural complications decreased significantly following the transition from transdiaphragmatic to sub-xiphoid surgical access: 23% versus 3.8% (P = .005) CONCLUSIONS: In a large, consecutive series of patients with predominantly PeAF, the CP was capable of reducing AF burden to very low levels (generally <5%), which appeared durable over time. Complication rates associated with the CP decreased significantly with the transition from transdiaphragmatic to sub-xiphoid surgical access. Future trials will be necessary to determine which patients are most likely to benefit from the convergent approach.
(© 2020 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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