ATRIAL FIBRILLATION ABLATION. OUR FIRST RESULTS
O.V. Sapelnikov, P.V. Mezentsev, A.S. Partigulova, I.R. Grishin, R.S Latypov, S.V. Chapyrnikh, R.S Akchurin
Cardiology Research Center, Dpt of Cardiovascular Surgery, Moscow, Russia Volyn Hospital no 1 of the President Administration, Moscow, Russia Hospital of the Ministry of Internal Affairs, Moscow, Russia
Introduction: The number of AF-ablation procedures are rapidly growing, and the results are being actively studied at present. Currently, there are still many unresolved issues that have accumulated as they gain experience.
Materials and Methods: From 2011 up to 05.2013 we treated 143 patients. We used Chilli II closed irrigated and Blazer Open Irrigated systems (Boston Scientific), AcuNav ultrasound 10 F sensors (Siemens) in catheter ablation group.
1st group – catheter ablation procedure in paroxysmal AF - 86
2nd group – catheter ablation procedure in persistent AF patients – 57.
Results: Mean age was 58 years, left atrial size was 4.0 cm (68.5 ml) without significant differences in the groups. In 1st group we’ve got 84.9% of success, including 13 patients with 2nd procedure (average 14 months of follow-up). We made PV-isolation protocol with the following provoking AF by rapid left atrial stimulation. In 2nd group with persistent AF we’ve got totally 68% of patients free from AF in 1 year of follow-up. We extended our protocol to posterior wall isolation, ablation of CFAFs, CS-isolation, trying to get a sinus rhythm during delivering of ablating lesions.
We observed 9 complicated cases (6.3%) in groups of patients: puncture of the aorta, which required surgery; penetration of contrast into the pericardium cavity during transseptal puncture without hemopericardium; and 6 hemopericardiums after transseptal puncture and after pumping during left veins isolation. In 5 cases we successfully completed the procedure using ICE. Once we have seen a case of cortical blindness, which recovered after treatment started immediately.
Conclusions: AF ablation is very effective and safe even in persistent and permanent AF
Sinus rhythm restoration during ablation delivery – is a strong predictor of long-standing sinus rhythm in patients with persistent AF.
ICE can prevent complications of transseptal puncture, helps to navigate in left atrium, to monitor complacations and more comfortable both to surgeon and patient than TEE. It should be a routine procedure during AF ablation.
