Catheter Ablation for Atrial Fibrillation in the Critical Care Medicine Department, Cairo University: A Retrospective Analysis
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- Category: Vol. 82, March 2014
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Catheter Ablation for Atrial Fibrillation in the Critical Care Medicine Department, Cairo University: A Retrospective Analysis, HASSAN K. NAGY, MOHAMED A. HAMOUDA, KHALED TEAMA and AHMED TAHER
Abstract
Background: Ablation of atrial fibrillation (AF) is a rapidly growing field with advanced technological progress that is supposed to improve success rate and decrease complications. We intended in this study to evaluate complications and recurrence following AF ablation by Lasso, CARTO, and combined techniques in Critical Care Medicine Department, Cairo University.
Methods: This is a retrospective study involving patients who underwent RF ablation of AF in the period between March 2004 and March 2009 in Critical Care Department, Cairo University. Patient data were collected from their medical records. Follow-up was done to the patient through in the follow up clinic or phone guided. According to the ablation technique, the study population was divided into 3 groups; patients for whom ablation done guided by Lasso catheter (Lasso group), patients for whom ablation done guided by CARTOTM XP system (Carto group), and those for whom ablation done guided by both Lasso catheter and CARTOTM XP system (combined group). Recurrence of AF was defined by the presence of symptomatic episodes of palpitation and documented ECG or 24 hours Holter showing AF. Freedom of AF is considered if there were no attacks of palpitations and at least two ECG’s showing sinus rhythm, obtained in two different follow up visits.
Results: The study included 58 pts with mean age of 43±11 yrs, 35 (60.3%) males. AF ablation was done by Lasso technique in 29 pts (50%), by Carto technique in 16 pts (27.6%), and by combined technique in 13 pts (22.4%). Apart from the higher number of antiarrhythmic drugs and the larger left atrial dimension in the Lasso group, the three groups revealed no significant differences in their demographic Characteristics. The overall freedom of AF following ablation was 62% at 5 yrs with a non-significant trend toward freedom of AF in the combined group. It was 76.9% in combined group compared to 57.1% and 60% in Lasso and Carto groups respectively (p=0.59). We reported an overall complication rate of 17.2% including 12. 1 % pericardial effusion and 3.4% for pulmonary vein stenosis and thromboembolism. There was a non-significant tendency toward more complications in Lasso group (27.6%) compared to Carto group (6.3%) and combined group (15.4%) (p=0.32).
Conclusions: Radiofrequency ablation is a safe and effec-tive long-term treatment strategy for drug-refractory atrial fibrillation. All techniques are successful but it seems that ablation technique guided by both CARTOTM XP navigation system and Lasso catheter has better long term outcome and less complication rate than ablation guided by either of them alone.