Efficacy and Safety of Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

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Abstract

Introduction: Radiofrequency catheter ablation of atrial fibrillation is more effective than antiarrhythmic drugs for symptoms
control, particularly in paroxysmal atrial fibrillation. The procedure is laborious and complex and not exempt from complications.
Objective: The aim of this study was to evaluate the outcomes of radiofrequency catheter ablation in a consecutive and selected population with recurrent atrial fibrillation refractory to antiarrhythmic drugs.
Methods: One-hundred and eleven patients (90 men) with paroxysmal (n = 75) or persistent (n = 36) atrial fibrillation, refractory to 2 (1.5-3) antiarrhythmic drugs were selected for radiofrequency catheter ablation. All the procedures were performed following a uniform methodology. Mean age was 56 ± 11 years, left atrial diameter was 41.5 (39-45) mm and left ventricular ejection fraction was 60% (56.5-66.5%). A total of 126 radiofrequency catheter ablation procedures were performed, including 15 second procedures, and 476/489 (97.3%) pulmonary veins were isolated. Twenty-five patients (22.5%) presented spontaneous ectopic activity in the pulmonary veins. Nonfatal complications occurred in 7/126 procedures (5.5%) and were satisfactorily resolved. Three patients presented vascular complications; other complications included one related to anesthesia, one subacute cardiac tamponade, one pericarditis without effusion and one pulmonary vein stenosis.After 22-month follow-up (13-35 months), 83 patients (74.8%) remained in sinus rhythm without antiarrhythmic drugs. The remaining 28 patients (25.2%) presented recurrences. Four of these patients had a favorable response to these previously inefficient
drugs, 8 had atrial fibrillation in spite of receiving antiarrhythmic drugs and 1 patient will undergo a new ablation. The remaining 15 patients underwent a second ablation procedure; 10 of them are recurrence-free after 12 (9-31) months.
Conclusion: In this consecutive series of patients with atrial fibrillation refractory to drugs, radiofrequency catheter ablation showed an adequate rate of success and low level of complications.