Europace Advance Access originally published online on July 29, 2008
Europace 2008 10(9):1085-1090; doi:10.1093/europace/eun197
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Ablation for Atrial Fibrillation
Radiofrequency ablation of drug-refractory atrial fibrillation: an observational study comparing ‘ablate and pace’ with pulmonary vein isolation
1 Department of Cardiology, Azienda Ospedaliera-Universitaria and IRCAB Foundation, P.le S. Maria della Misericordia, 15, 33100 Udine, Italy; 2 Department of Cardiology, Azienda Ospedaliera S, Bortolo-Vicenza, Italy; 3 Department of Cardiology, Azienda Ospedaliera S, Maria dei Battuti-Treviso, Italy; 4 Department of Public Health, University of Torino, Turin, Italy
Aims: To compare clinical characteristics, procedure complexity, acute and long-term outcome of ‘ablate and pace’ (A&P) with pulmonary vein isolation (PVI) in patients with drug-refractory atrial fibrillation (AF). So far, only few small studies have compared the two procedures.
Methods and results: We analysed retrospectively a cohort of symptomatic consecutive patients with drug-refractory AF. Group 1 included 100 patients treated with A&P and Group 2 included 144 patients treated with PVI. Group 1 patients were older (74 ± 8 vs. 56 ± 9 years; P < 0.0001), had lower left ventricular ejection fraction (50 ± 13% vs. 59 ± 7%; P < 0.05), and a lower prevalence of paroxysmal AF (46% vs. 65%; P < 0.05). Acute success was not statistically different (98% vs. 92.3%, P = ns). Group 1 patients had shorter procedure time and lower radiation exposure with respect to Group 2 patients (70 ± 15 vs. 204 ± 58 min, and 8 ± 4 vs. 57 ± 22 min; P < 0.0001, respectively). After a median follow-up of 29 months (I, III quartile; 15, 40 months) vs. 25 months (I, III quartile; 8, 36 months) (P = ns), all the patients in Group 1 were free of symptomatic AF, while 113 patients (79%) of Group 2 were in stable sinus rhythm (P < 0.0001). Persistent or permanent AF has been documented in 58 patients (58%) of Group 1 vs. 11 (8%) of Group 2 (P < 0.0001).
Conclusion: In this series (i) patients treated with A&P and PVI for drug-refractory AF showed significant differences in clinical profile; (ii) A&P is a shorter and less complex procedure, but is associated with a higher rate of persistent AF; (iii) symptomatic recurrences of paroxysmal AF were more frequent in PVI group. Randomized studies appear necessary to identify the best strategy in selected cases.
Key Words: Ablate and pace, Isolation of the pulmonary veins, Drug refractory atrial fibrillation
* Corresponding author. Tel: +39 (0) 432552440; fax: +39 (0) 432482353.E-mail address: ap.ircab{at}gmail.com
Manuscript submitted 9 May 2008. Accepted after revision 7 August 2008.
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