Aim: The success rate of pulmonary vein isolation (PVI) alone for persistent AF was reported as 20-61%; ablation of sites of complex fractionated atrial electrograms alone: 9-85%; and combined techniques: 42-95% success rates, but half of patients require at least two procedures for secondary atrial tachy-arrhythmias. We describe our approach to ablation of persistent AF using circular ablation catheters.
Methods: Patients with AF of unknown age undergo DC cardioversion in the EP laboratory and if sinus is maintained for at least 3 minutes– we further ablate. Redo procedures and long-persistent AF undergo PVI with additional lines (using MAAC, MASC, or nMARQ catheters for left lines and irrigated-tip catheter for right sided lines). EPS is done post PVI to induce triggers and ablate them. In patients who enter procedure in AF rhythm- ablation of right PVs, then DC cardioversion and completing PVI in sinus rhythm is applied– for better signal recording and proving isolation.
Results: We studied prospectively 33 consecutive patients who underwent persistent AF ablation using circular catheters (25 PVAC® and 8 nMARQ™) in our center between 7/2011- 11/2013. Average age was 63 ± 11y, 76% male, 36% long persistent AF, and 3 redo AF ablations. Post PVI, triggers were recognized in 6/33 (18%) patients. Additional lines and RF ablation were needed in 13/33 (39%) of patients. All procedures were performed under conscious sedation with 117 ± 49 minutes procedure time and 41 ± 24 minutes fluoroscopy time. Complication rates were: 2 pseudo-aneurysm and 1 transient ST elevation. 3, 6 & 12 months freedom from AF were (available data): 21/24 (87%), 10/12 (83%), and 7/8 (87%), respectively. 11/24 (46%) with available data discontinued AAD, one was referred for a redo procedure, and 1 for pacemaker implantation and AVN ablation
Conclusions: Our preliminary results in a small group of patients imply that our approach for ablation of persistent atrial fibrillation using circular catheters is safe and effective. A larger study is needed to validate these conclusions.
