Radiofrequency catheter ablation of focal AF triggers achieved persistent sinus rhythm in 33% of patients, but carried a 68% recurrence rate and an 8.3% risk of pulmonary vein stenosis.
Cohort (n=71)
Does radiofrequency catheter ablation of focal AF triggers improve quality of life and symptoms in patients with paroxysmal AF?
While radiofrequency ablation of focal AF triggers improves quality of life even in patients with recurrences, it is associated with a high recurrence rate and a significant risk of pulmonary vein stenosis.
INTRODUCTION: Ablative therapy for atrial fibrillation (AF) by targeting initiating triggers, usually in or around the pulmonary veins, has been reported by several centers. Evidence for an overall improvement in quality of life (QOL) and amelioration of symptoms is lacking. METHODS AND RESULTS: Seventy-one patients undergoing attempted ablation of focal AF were followed for 60+/-33 weeks. QOL and symptom questionnaires were completed 1 month before and 6 months after electrophysiologic study. Twenty-three patients (32%) underwent electrophysiologic mapping but no ablation because of either insufficient or multifocal ectopy; the other 48 patients (68%) underwent attempted ablation. Sixteen of 48 patients (33%) undergoing ablation, or 16 (23%) of 71 on an intention-to-treat basis, were found at last follow-up to have persistent sinus rhythm without antiarrhythmic drugs. Patients who underwent mapping without ablation reported no improvements in any QOL or symptom score, whereas patients who had long-term successful ablation had significant improvements in all six QOL measures. Interestingly, patients who developed AF recurrence after ablation still reported significant improvements in 4 of 6 QOL measures. Four of 48 patients (8.3%) undergoing ablation developed pulmonary vein stenosis. CONCLUSION: Paroxysmal AF can be treated successfully in some patients by ablating initiating triggers in the pulmonary veins; however, in our experience the recurrence rate (32/48 68%) and risk of pulmonary vein stenosis (8%) after ablation are high. Patients with recurrent AF after ablation of focal AF triggers have significant improvement in QOL and symptoms compared with before ablation. Patients and their physicians should carefully balance the risks and benefits before considering ablation.
Gerstenfeld et al. (2001) conducted a cohort in Focal atrial fibrillation (n=71). Radiofrequency catheter ablation of focal AF triggers vs. Electrophysiologic mapping without ablation was evaluated on Persistent sinus rhythm without antiarrhythmic drugs. Radiofrequency catheter ablation of focal AF triggers achieved persistent sinus rhythm in 33% of patients, but carried a 68% recurrence rate and an 8.3% risk of pulmonary vein stenosis.