Catheter Ablation of Atrial Fibrillation: Outcomes, Complications and Strategies

This abstract oral session featured top cardiology researchers who were given a mere 15 minutes to review the highlights of their most recent work. The reasons for their studies and what they found are covered below.

Early Rhythm Control Strategy by Catheter Ablation in Patients with Paroxysmal Atrial Fibrillation: The 4-year Results of a Randomize Follow-up Study Comparing Catheter Ablation and Antiarrhythmic Drug Therapy: The APAF 2 StudyVicenzo Santinelli, Andrea Radinovic, Gabriele Vicedomini, Giuseppe Ciconte, Giuseppe Augello, Simone Sala, Alessia Pappone, Massimo Saviano, Cristiano Ciaccio, Simone Gulletta, Patrizio Mazzone, and Carlo Pappone, San Raffaele University Hospital, Milan, Italy

On behalf of her colleagues, Radinovic explained that their study was conducted because not data are available on the "potential long-term superiority of catheter ablation (CA) over antiarrhythmic drugs (AADs) in patients with paroxysmal atrial fibrillation (AF). When looking at the cases of 198 patients who were randomized to CPVA or AADs, the team determined that "catheter ablation remains superior to AADs at 4-year follow-up despite crossover to CA for almost all patients initially randomized to AADs," indicating that an early "CA strategy is preferable in terms of efficacy, adverse events, QoL, and arrhythmia progression.

The Permanency of PV Isolation with a Cryoballon Catheter During AF AblationHumera Ahmed, Andre d'Avila, and Vivek Y. Reddy, Mount Sinai Hospital, New York, NY; Petr Neuzil, Homolka Hospital, Prague, Czech Republic; and David M. Donaldson and Margaret Laragy, Massachusetts General Hospital, Boston, MA

Ahmed explained that this study was conducted to provide data on the durability of pulmonary vein isolation (PVI), for which balloon cryoablation is being increasingly employed and which remains elusive with RF ablation. Ahmed explain that the research team feels their finding that "the cryoballoon ablation procedure is able to achieve persistent isolation in most PVs" might "represent a significant step toward standardizing the PVI procedure."

Intraesophageal Temperature Monitoring During Radiofrequency Catheter Ablation of Atrial Fibrillation: Does it Predict Esophageal Injury?Simon Kircher, Thomas Gaspar, Gerhard Hindricks, Charlotte Eitel, Andrea Bollman, Ulrike Wetzel, Arash Arya, Daniela Bollman, Phillip Sommer, and Christopher Piorkowski, Heart Center Leipzig, Leipzig, Germany

Kircher stated, on behalf of this colleagues, that their research aimed to "evaluate the relationship 1) between the course of the esophagus and the site of radiofrequency (RF) energy delivery associated with an increase in intraesophageal temperature (IET) measured by an intraluminal temperature probe and (2) between the incidence of mucosal damage as evidenced by esophageal endoscopy (EES) and IET." Their finding that IET increases mostly occur when ablation is performed closely to the esophagus, with mucosal injury extent related strongly to IET, isn't surprising, but that IET had to be reduced in 136 of 153 patients (89%) is alarming. Kircher suggested that "using a cut-off value of 41^â—¦C to drive postprocedural EES might help to identify [patients] at a higher risk for esophageal complications after RF catheter ablation of AF."

Regional Distribution and Characteristics of Complex Fractionated Atrial Electrogram in Electroanatomically Remodeled Left Atrium in Patients with Atrial FibrillationJae Hyung Park, Hui-Nam Pak, Sook Kyoung Kim, Euy Seok Hwang, Moon Hyung Lee, and Sung Soon Kim, Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea; Jong Il Choi and Young-Hoon Kim, Korea University College of Medicine, Seoul, Republic of Korea; and Chun Hwang, Utah Valley Medical Center, Provo, UT

This research study, explained Park, was conducted because up until its findings were confirmed, it had "not been clearly demonstrated whether the pattern of complex fractionated atrial electrogram (CFAEs) during atrial fibrillation (AF) is related to electro-anatomical remodeling and left atrial (LA) volume of the LA." Park's team found that the proportion of CFAE area in AF patients with electroanatomically remodeled LA was smaller and regional CFAE-cycle length was longer than in AF patients with a normal LA size. Additionally, they determined that the "patterns of CFAE were closely related to the degree of electro-anatomical remodeling of LA."