Purpose: Guidelines underline the need for long-term follow-up to assess the efficacy of atrial fibrillation (AF) ablation. We evaluated in patients with persistent AF and valvular heart disease the very long-term follow-up efficacy of an ablation strategy consisting of surgical pulmonary veins (PVs) isolation and left atrial linear lesions validated by electroanatomic mapping (EAM) associated with endocardial radiofrequency ablation in case of lesion incompleteness. Methods: From 2000 to 2002, 33 patients with persistent AF and valvular heart disease underwent valve surgery and cryoablation (PVs isolation and left atrial linear lesions). Ablation scheme surgically created was validated with EAM and percutaneous transcatheter radiofrequency ablation was performed in case of lesion incompleteness. Results: In 19/33 patients (58%) the EAM showed a complete lesion scheme, which increased to 79% (26/33) with the addition of radiofrequency ablation. At the mean follow-up of 10.7±3.1 years, 73% (24/33) of patients were in sinus rhythm (SR), whereas 27% had permanent AF. At the end of follow-up 81% of patients with a complete lesion scheme were in SR, while 43% with an incomplete one maintained SR (p=0.048). Conclusions: In patients with persistent AF and valvular heart disease, the hybrid approach with surgical cryoablation consisting of PVs isolation and left atrial linear lesions combined with transcatheter radiofrequency ablation showed to be highly effective in maintaining SR in a very long-term follow-up. An electrophysiological evaluation, to validate the transmurality of the surgical lesions and to complete the lesion scheme applying radiofrequency energy, allowed to improve the long-term efficacy.
Long-term (>10 years) clinical results and electroanatomic correlations of persistent atrial fibrillation ablation with a hybrid approach in patients with valvular heart disease
GAITA, Fiorenzo;EBRILLE, ELISA;
2013-01-01
Abstract
Purpose: Guidelines underline the need for long-term follow-up to assess the efficacy of atrial fibrillation (AF) ablation. We evaluated in patients with persistent AF and valvular heart disease the very long-term follow-up efficacy of an ablation strategy consisting of surgical pulmonary veins (PVs) isolation and left atrial linear lesions validated by electroanatomic mapping (EAM) associated with endocardial radiofrequency ablation in case of lesion incompleteness. Methods: From 2000 to 2002, 33 patients with persistent AF and valvular heart disease underwent valve surgery and cryoablation (PVs isolation and left atrial linear lesions). Ablation scheme surgically created was validated with EAM and percutaneous transcatheter radiofrequency ablation was performed in case of lesion incompleteness. Results: In 19/33 patients (58%) the EAM showed a complete lesion scheme, which increased to 79% (26/33) with the addition of radiofrequency ablation. At the mean follow-up of 10.7±3.1 years, 73% (24/33) of patients were in sinus rhythm (SR), whereas 27% had permanent AF. At the end of follow-up 81% of patients with a complete lesion scheme were in SR, while 43% with an incomplete one maintained SR (p=0.048). Conclusions: In patients with persistent AF and valvular heart disease, the hybrid approach with surgical cryoablation consisting of PVs isolation and left atrial linear lesions combined with transcatheter radiofrequency ablation showed to be highly effective in maintaining SR in a very long-term follow-up. An electrophysiological evaluation, to validate the transmurality of the surgical lesions and to complete the lesion scheme applying radiofrequency energy, allowed to improve the long-term efficacy.
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